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[null,"保険医療機関等定例報告用ツール"]
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[null,"都道府県コード\n（選択してください）",null,"医療機関コード\n（半角数字7桁）",null,"医療機関種別\n（選択してください）",null,null,"医療機関名称"]
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[null,"【操作上の注意】"]
[null,"１．提出対象の別紙様式シートを全て入力した上で、都道府県コード・医療機関コード・医療機関種別・医療機関名称を入力し、"]
[null,"　　「令和6年度別紙様式一覧」から提出対象の別紙様式のチェックボックスを全て選択して「出力」ボタンをクリックしてください。"]
[null,"２．「出力」ボタンをクリックして出力されたCSVファイルを、保険医療機関等電子申請・届出等システムにアップロードしてください。"]
[null,"３．医療機関種別は、医科の場合は「１　病院」「２　医科（有床診療所）」「３　医科（無床診療所）」から該当するもの、"]
[null,"　　歯科の場合は「４　歯科診療所」、薬局の場合は「５　薬局」を選択してください。"]
[null,"４．シートの追加・削除・並び順変更・名前変更等は行わないでください。"]
[]
[null,null,null,"チェックボックスで選択した別紙様式をCSVファイルとしてデータ出力します。\n入力チェックを行います。"]
[]
[null,null,null,"全シートの入力内容を初期状態に戻します。"]
[]
[null,null,null,"チェックボックスで選択した別紙様式を印刷します。"]
[]
[null,null,null,"ツールから出力したCSVファイルを読み込みます。"]
[]
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[null,"令和6年度別紙様式一覧"]
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["1000","1006","","別紙様式１０","報告年月日-日",1,1,0,2,"","","1000","1006","",7,"M","",null,"","-"]
["1000","1007","","別紙様式１０","本管理料を算定した患者数","",1,0,8,"3.入力内容チェック","A","1000","1007","",9,"J","",null,"","-"]
["1000","1008","","別紙様式１０","①のうち、当該期間後の７月末日までに１２週間にわたる計５回の禁煙治療を終了した者","",1,0,8,"3.入力内容チェック\n4.入力内容チェック","B","1000","1008","",12,"J","",null,"","-"]
["1000","1009","","別紙様式１０","②のうち、禁煙に成功した者","",1,0,8,"4.入力内容チェック\n5.入力内容チェック","C","1000","1009","",14,"J","",null,"","-"]
["1000","1010","","別紙様式１０","５回の指導を最後まで行わずに治療を中止した者（①－②）のうち、中止時に禁煙していた者","",1,0,8,"3.入力内容チェック","","1000","1010","",16,"J","",null,"","-"]
["1000","1011","","別紙様式１０","ニコチン依存症管理料１のイに掲げる初回の治療の算定回数","",1,0,8,"","","1000","1011","",18,"J","",null,"","-"]
["1000","1012","","別紙様式１０","ニコチン依存症管理料２の算定回数","",1,0,8,"","","1000","1012","",20,"J","",null,"","-"]
["1000","1013","","別紙様式１０","ニコチン依存症管理料１の一年間の延べ算定回数","",1,0,8,"","","1000","1013","",22,"J","",null,"","-"]
["1000","1014","","別紙様式１０","ニコチン依存症管理料２を算定した患者の延べ指導回数","",1,0,8,"","","1000","1014","",25,"J","",null,"","-"]
["1000","1015","","別紙様式１０","①のうち、禁煙治療補助システム指導管理加算を算定したもの","",1,0,8,"3.入力内容チェック","","1000","1015","",27,"J","",null,"","-"]
["1000","1016","","別紙様式１０","②のうち、禁煙治療補助システム指導管理加算を算定したもの","",1,0,8,"4.入力内容チェック","","1000","1016","",29,"J","",null,"","-"]
["1000","1017","","別紙様式１０","③のうち、禁煙治療補助システム指導管理加算を算定したもの","",1,0,8,"5.入力内容チェック","","1000","1017","",31,"J","",null,"","-"]
["1000","1018","","別紙様式１０","喫煙を止めたものの割合","",1,0,3,"","","1000","1018","70",34,"K","nochange",null,1,0]
["1000","1019","","別紙様式１０","治療の平均継続回数","",1,0,10,"","","1000","1019","1",35,"K","nochange",null,3,1]
["1100","7001","","別紙様式１１-１（診療所）","保険医療機関名",1,"",0,101,"","","1100","7001","テスト",6,"M","medInstName",null,null,0,null,null,101,null,null,"-",null,null,null,null,null,"-",null,null,"M",null,null,6,null,null,"-",null,null,"-",null,null,"medInstName"]
["1100","7002","","別紙様式１１-１（診療所）","医療機関コード",1,1,0,7,"1.桁数チェック","DCM","1100","7002","0123456",7,"M","nochange",null,null,0,null,null,7,null,null,"1.桁数チェック",null,null,null,null,null,"DCM",null,null,"M",null,null,7,null,null,"-",null,null,"-",null,null,"nochange"]
["1100","7003","","別紙様式１１-１（診療所）","別添1の「第9の1」の1に規定する在宅療養支援診療所の区分",1,"","","","2.入力内容チェック\n3.入力内容チェック","AH","1100","7003","",9,"E","",null,null,"-",null,null,"-",null,null,"2.入力内容チェック\n3.入力内容チェック",null,null,null,null,null,"AH",null,null,"E",null,null,9,null,null,"-",null,null,"-",null,null,"-"]
["1100","7004","","別紙様式１１-１（診療所）","実績加算届出","","","","","2.入力内容チェック","","1100","7004","",11,"O","",null,null,"-",null,null,"-",null,null,"2.入力内容チェック",null,null,null,null,null,"-",null,null,"O",null,null,11,null,null,"-",null,null,"-",null,null,"-"]
["1100","7005","","別紙様式１１-１（診療所）","Ⅰ.直近1年間に在宅療養を担当した患者について-平均診療期間","",1,0,5,"","","1100","7005","",14,"O","",null,null,0,null,null,5,null,null,"-",null,null,null,null,null,"-",null,null,"O",null,null,14,null,null,"-",null,null,"-",null,null,"-"]
["1100","7006","","別紙様式１１-１（診療所）","Ⅰ.直近1年間に在宅療養を担当した患者について-合計診療患者数","",1,0,8,"","","1100","7006","",15,"O","",null,null,0,null,null,8,null,null,"-",null,null,null,null,null,"-",null,null,"O",null,null,15,null,null,"-",null,null,"-",null,null,"-"]
["1100","7007","","別紙様式１１-１（診療所）","Ⅰ.直近1年間に在宅療養を担当した患者について-【再掲】死亡患者数","",1,0,9,"","","1100","7007","70",16,"O","nochange",null,null,0,null,null,9,null,null,"-",null,null,null,null,null,"-",null,null,"O",null,null,16,null,null,"-",null,null,"-",null,null,"nochange"]
["1100","7008","","別紙様式１１-１（診療所）","Ⅰ.直近1年間に在宅療養を担当した患者について-（１）うち医療機関以外での死亡者数","",1,0,9,"","","1100","7008","50",17,"O","nochange",null,null,0,null,null,9,null,null,"-",null,null,null,null,null,"-",null,null,"O",null,null,17,null,null,"-",null,null,"-",null,null,"nochange"]
["1100","7009","","別紙様式１１-１（診療所）","Ⅰ.直近1年間に在宅療養を担当した患者について-ア　うち自宅での死亡者数","",1,0,8,"","","1100","7009","",18,"O","",null,null,0,null,null,8,null,null,"-",null,null,null,null,null,"-",null,null,"O",null,null,18,null,null,"-",null,null,"-",null,null,"-"]
["1100","7010","","別紙様式１１-１（診療所）","Ⅰ.直近1年間に在宅療養を担当した患者について-イ　うち自宅以外での死亡者数","",1,0,8,"","","1100","7010","",19,"O","",null,null,0,null,null,8,null,null,"-",null,null,null,null,null,"-",null,null,"O",null,null,19,null,null,"-",null,null,"-",null,null,"-"]
["1100","7011","","別紙様式１１-１（診療所）","Ⅰ.直近1年間に在宅療養を担当した患者について-（２）うち医療機関での死亡者数","",1,0,9,"","","1100","7011","20",20,"O","nochange",null,null,0,null,null,9,null,null,"-",null,null,null,null,null,"-",null,null,"O",null,null,20,null,null,"-",null,null,"-",null,null,"nochange"]
["1100","7012","","別紙様式１１-１（診療所）","Ⅰ.直近1年間に在宅療養を担当した患者について-ア　うち連携医療機関での死亡者数","",1,0,8,"","","1100","7012","",21,"O","",null,null,0,null,null,8,null,null,"-",null,null,null,null,null,"-",null,null,"O",null,null,21,null,null,"-",null,null,"-",null,null,"-"]
["1100","7013","","別紙様式１１-１（診療所）","Ⅰ.直近1年間に在宅療養を担当した患者について-イ　うち連携医療機関以外での死亡者数","",1,0,8,"","","1100","7013","",22,"O","",null,null,0,null,null,8,null,null,"-",null,null,null,null,null,"-",null,null,"O",null,null,22,null,null,"-",null,null,"-",null,null,"-"]
["1100","7014","",{"$f":"IF(AND(A1704=\"0600\",LEFT(B1704,1)=\"0\"),VLOOKUP(\"0601\",SheetName,2,FALSE),IF(AND(A1704=\"0600\",LEFT(B1704,1)=\"1\"),VLOOKUP(\"0602\",SheetName,2,FALSE),IF(AND(A1704=\"1100\",LEFT(B1704,1)=\"7\"),VLOOKUP(\"1113\",SheetName,2,FALSE),IF(AND(A1704=\"1100\",LEFT(B1704,1)=\"8\"),VLOOKUP(\"1123\",SheetName,2,FALSE),VLOOKUP(A1704,SheetName,2,FALSE)))))","v":"別紙様式１１-１（診療所）"},"Ⅰ.直近1年間に在宅療養を担当した患者について-超重症児又は準超重症児の患者数","",1,0,8,"","","1100","7014","",23,"O","",null,null,0,null,null,8,null,null,"-",null,null,null,null,null,"-",null,null,"O",null,null,23,null,null,"-",null,null,"-",null,null,"-"]
["1100","7015","","別紙様式１１-１（診療所）","Ⅱ直近1年間の訪問診療等の実施回数について-訪問診療等の合計回数","",1,0,8,"","","1100","7015","240",32,"B","nochange",null,null,0,null,null,8,null,null,"-",null,null,null,null,null,"-",null,null,"B",null,null,32,null,null,"-",null,null,"-",null,null,"nochange"]
["1100","7016","","別紙様式１１-１（診療所）","Ⅱ直近1年間の訪問診療等の実施回数について-（１）往診","",1,0,8,"7.入力内容チェック","","1100","7016","",32,"G","",null,null,0,null,null,8,null,null,"7.入力内容チェック",null,null,null,null,null,"-",null,null,"G",null,null,32,null,null,"-",null,null,"-",null,null,"-"]
["1100","7017","","別紙様式１１-１（診療所）","Ⅱ直近1年間の訪問診療等の実施回数について-（１）往診-【再掲】うち緊急の往診","",1,0,8,"7.入力内容チェック","AK","1100","7017","",32,"J","",null,null,0,null,null,8,null,null,"7.入力内容チェック",null,null,null,null,null,"AK",null,null,"J",null,null,32,null,null,"-",null,null,"-",null,null,"-"]
["1100","7018","","別紙様式１１-１（診療所）","Ⅱ直近1年間の訪問診療等の実施回数について-（２）訪問診療","",1,0,8,"","","1100","7018","",32,"M","",null,null,0,null,null,8,null,null,"-",null,null,null,null,null,"-",null,null,"M",null,null,32,null,null,"-",null,null,"-",null,null,"-"]
["1100","7019","","別紙様式１１-１（診療所）","Ⅱ直近1年間の訪問診療等の実施回数について-（３）訪問看護（緊急を含む）","",1,0,8,"","","1100","7019","",32,"P","",null,null,0,null,null,8,null,null,"-",null,null,null,null,null,"-",null,null,"P",null,null,32,null,null,"-",null,null,"-",null,null,"-"]
["1100","7020","","別紙様式１１-１（診療所）","Ⅴ.在宅支援連携体制について-在宅医療を担当する常勤の医師数","",1,0,4,"3.入力内容チェック","","1100","7020","",59,"K","",null,null,0,null,null,4,null,null,"3.入力内容チェック",null,null,null,null,null,"-",null,null,"K",null,null,59,null,null,"-",null,null,"-",null,null,"-"]
["1100","7021","","別紙様式１１-１（診療所）","Ⅴ.在宅支援連携体制について-連携する保険医療機関数","",1,0,5,"3.入力内容チェック","","1100","7021","",60,"K","",null,null,0,null,null,5,null,null,"3.入力内容チェック",null,null,null,null,null,"-",null,null,"K",null,null,60,null,null,"-",null,null,"-",null,null,"-"]
["1100","7022","","別紙様式１１-１（診療所）","Ⅲ.直近1ヶ月間における往診又は訪問診療の状況について-初診、再診、往診又は訪問診療を実施した患者数","",1,0,8,"","","1100","7022","",37,"J","",null,null,0,null,null,8,null,null,"-",null,null,null,null,null,"-",null,null,"J",null,null,37,null,null,"-",null,null,"-",null,null,"-"]
["1100","7023","","別紙様式１１-１（診療所）","Ⅲ.直近1ヶ月間における往診又は訪問診療の状況について-往診又は訪問診療を実施した患者数","",1,0,8,"","","1100","7023","",38,"J","",null,null,0,null,null,8,null,null,"-",null,null,null,null,null,"-",null,null,"J",null,null,38,null,null,"-",null,null,"-",null,null,"-"]
["1100","7024","","別紙様式１１-１（診療所）","Ⅲ.直近1ヶ月間における往診又は訪問診療の状況について-往診又は訪問診療を実施した患者の割合","",1,0,8,"5.入力内容チェック","AI","1100","7024","97",39,"J","nochange",null,null,0,null,null,8,null,null,"5.入力内容チェック",null,null,null,null,null,"AI",null,null,"J",null,null,39,null,null,"切り捨て",null,null,2,null,null,"nochange"]
["1100","7025","","別紙様式１１-１（診療所）","Ⅳ.主として往診又は訪問診療を実施する診療所に係る状況-直近1年間に、訪問診療を開始した患者の紹介を受けた保険医療機関-保険医療機関の名称1","","",0,101,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック","AJ","1100","7025","",44,"C","",null,null,0,null,null,101,null,null,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック",null,null,null,null,null,"AJ",null,null,"C",null,null,44,null,null,"-",null,null,"-",null,null,"-"]
["1100","7026","","別紙様式１１-１（診療所）","Ⅳ.主として往診又は訪問診療を実施する診療所に係る状況-直近1年間に、訪問診療を開始した患者の紹介を受けた保険医療機関-患者の紹介を行った医師1","","",0,100,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック","","1100","7026","",44,"I","",null,null,0,null,null,100,null,null,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック",null,null,null,null,null,"-",null,null,"I",null,null,44,null,null,"-",null,null,"-",null,null,"-"]
["1100","7027","","別紙様式１１-１（診療所）","Ⅳ.主として往診又は訪問診療を実施する診療所に係る状況-直近1年間に、訪問診療を開始した患者の紹介を受けた保険医療機関-患者の紹介を受けた日付1","","","",25,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック","","1100","7027","",44,"N","",null,null,"-",null,null,25,null,null,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック",null,null,null,null,null,"-",null,null,"N",null,null,44,null,null,"-",null,null,"-",null,null,"-"]
["1100","7028","","別紙様式１１-１（診療所）","Ⅳ.主として往診又は訪問診療を実施する診療所に係る状況-直近1年間に、訪問診療を開始した患者の紹介を受けた保険医療機関-保険医療機関の名称2","","",0,101,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック","AJ","1100","7028","",45,"C","",null,null,0,null,null,101,null,null,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック",null,null,null,null,null,"AJ",null,null,"C",null,null,45,null,null,"-",null,null,"-",null,null,"-"]
["1100","7029","","別紙様式１１-１（診療所）","Ⅳ.主として往診又は訪問診療を実施する診療所に係る状況-直近1年間に、訪問診療を開始した患者の紹介を受けた保険医療機関-患者の紹介を行った医師2","","",0,100,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック","","1100","7029","",45,"I","",null,null,0,null,null,100,null,null,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック",null,null,null,null,null,"-",null,null,"I",null,null,45,null,null,"-",null,null,"-",null,null,"-"]
["1100","7030","","別紙様式１１-１（診療所）","Ⅳ.主として往診又は訪問診療を実施する診療所に係る状況-直近1年間に、訪問診療を開始した患者の紹介を受けた保険医療機関-患者の紹介を受けた日付2","","","",25,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック","","1100","7030","",45,"N","",null,null,"-",null,null,25,null,null,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック",null,null,null,null,null,"-",null,null,"N",null,null,45,null,null,"-",null,null,"-",null,null,"-"]
["1100","7031","","別紙様式１１-１（診療所）","Ⅳ.主として往診又は訪問診療を実施する診療所に係る状況-直近1年間に、訪問診療を開始した患者の紹介を受けた保険医療機関-保険医療機関の名称3","","",0,101,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック","AJ","1100","7031","",46,"C","",null,null,0,null,null,101,null,null,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック",null,null,null,null,null,"AJ",null,null,"C",null,null,46,null,null,"-",null,null,"-",null,null,"-"]
["1100","7032","","別紙様式１１-１（診療所）","Ⅳ.主として往診又は訪問診療を実施する診療所に係る状況-直近1年間に、訪問診療を開始した患者の紹介を受けた保険医療機関-患者の紹介を行った医師3","","",0,100,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック","","1100","7032","",46,"I","",null,null,0,null,null,100,null,null,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック",null,null,null,null,null,"-",null,null,"I",null,null,46,null,null,"-",null,null,"-",null,null,"-"]
["1100","7033","","別紙様式１１-１（診療所）","Ⅳ.主として往診又は訪問診療を実施する診療所に係る状況-直近1年間に、訪問診療を開始した患者の紹介を受けた保険医療機関-患者の紹介を受けた日付3","","","",25,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック","","1100","7033","",46,"N","",null,null,"-",null,null,25,null,null,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック",null,null,null,null,null,"-",null,null,"N",null,null,46,null,null,"-",null,null,"-",null,null,"-"]
["1100","7034","","別紙様式１１-１（診療所）","Ⅳ.主として往診又は訪問診療を実施する診療所に係る状況-直近1年間に、訪問診療を開始した患者の紹介を受けた保険医療機関-保険医療機関の名称4","","",0,101,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック","AJ","1100","7034","",47,"C","",null,null,0,null,null,101,null,null,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック",null,null,null,null,null,"AJ",null,null,"C",null,null,47,null,null,"-",null,null,"-",null,null,"-"]
["1100","7035","","別紙様式１１-１（診療所）","Ⅳ.主として往診又は訪問診療を実施する診療所に係る状況-直近1年間に、訪問診療を開始した患者の紹介を受けた保険医療機関-患者の紹介を行った医師4","","",0,100,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック","","1100","7035","",47,"I","",null,null,0,null,null,100,null,null,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック",null,null,null,null,null,"-",null,null,"I",null,null,47,null,null,"-",null,null,"-",null,null,"-"]
["1100","7036","","別紙様式１１-１（診療所）","Ⅳ.主として往診又は訪問診療を実施する診療所に係る状況-直近1年間に、訪問診療を開始した患者の紹介を受けた保険医療機関-患者の紹介を受けた日付4","","","",25,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック","","1100","7036","",47,"N","",null,null,"-",null,null,25,null,null,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック",null,null,null,null,null,"-",null,null,"N",null,null,47,null,null,"-",null,null,"-",null,null,"-"]
["1100","7037","","別紙様式１１-１（診療所）","Ⅳ.主として往診又は訪問診療を実施する診療所に係る状況-直近1年間に、訪問診療を開始した患者の紹介を受けた保険医療機関-保険医療機関の名称5","","",0,101,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック","AJ","1100","7037","",48,"C","",null,null,0,null,null,101,null,null,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック",null,null,null,null,null,"AJ",null,null,"C",null,null,48,null,null,"-",null,null,"-",null,null,"-"]
["1100","7038","","別紙様式１１-１（診療所）","Ⅳ.主として往診又は訪問診療を実施する診療所に係る状況-直近1年間に、訪問診療を開始した患者の紹介を受けた保険医療機関-患者の紹介を行った医師5","","",0,100,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック","","1100","7038","",48,"I","",null,null,0,null,null,100,null,null,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック",null,null,null,null,null,"-",null,null,"I",null,null,48,null,null,"-",null,null,"-",null,null,"-"]
["1100","7039","","別紙様式１１-１（診療所）","Ⅳ.主として往診又は訪問診療を実施する診療所に係る状況-直近1年間に、訪問診療を開始した患者の紹介を受けた保険医療機関-患者の紹介を受けた日付5","","","",25,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック","","1100","7039","",48,"N","",null,null,"-",null,null,25,null,null,"4.外字チェック\n6.入力内容チェック\n7.入力内容チェック",null,null,null,null,null,"-",null,null,"N",null,null,48,null,null,"-",null,null,"-",null,null,"-"]
["1100","7040","","別紙様式１１-１（診療所）","Ⅳ.主として往診又は訪問診療を実施する診療所に係る状況-在宅時医学総合管理料を算定した患者数","",1,0,8,"5.入力内容チェック","","1100","7040","",50,"O","",null,null,0,null,null,8,null,null,"5.入力内容チェック",null,null,null,null,null,"-",null,null,"O",null,null,50,null,null,"-",null,null,"-",null,null,"-"]
["1100","7041","","別紙様式１１-１（診療所）","Ⅳ.主として往診又は訪問診療を実施する診療所に係る状況-施設入居時医学総合管理料を算定した患者数","",1,0,8,"5.入力内容チェック","","1100","7041","",51,"O","",null,null,0,null,null,8,null,null,"5.入力内容チェック",null,null,null,null,null,"-",null,null,"O",null,null,51,null,null,"-",null,null,"-",null,null,"-"]
["1100","7042","","別紙様式１１-１（診療所）","Ⅳ.主として往診又は訪問診療を実施する診療所に係る状況-①及び②のうち、要介護３以上又は別表第八の二に規定する別に厚生労働大臣が定める状態に該当する患者数","",1,0,8,"5.入力内容チェック","","1100","7042","",52,"O","",null,null,0,null,null,8,null,null,"5.入力内容チェック",null,null,null,null,null,"-",null,null,"O",null,null,52,null,null,"-",null,null,"-",null,null,"-"]
["1100","7043","","別紙様式１１-１（診療所）","Ⅳ.主として往診又は訪問診療を実施する診療所に係る状況-施設入居時等医学総合管理料を算定した患者の割合","",1,0,6,"5.入力内容チェック","","1100","7043","62.5",53,"O","nochange",null,null,0,null,null,6,null,null,"5.入力内容チェック",null,null,null,null,null,"-",null,null,"O",null,null,53,null,null,"切り捨て",null,null,2,null,null,"nochange"]
["1100","7044","","別紙様式１１-１（診療所）","Ⅳ.主として往診又は訪問診療を実施する診療所に係る状況-要介護３又は別表第八の二に規定する別に厚生労働大臣が定める状態に該当する患者の割合","",1,0,6,"5.入力内容チェック","","1100","7044","18.75",54,"O","nochange",null,null,0,null,null,6,null,null,"5.入力内容チェック",null,null,null,null,null,"-",null,null,"O",null,null,54,null,null,"切り捨て",null,null,2,null,null,"nochange"]
["1100","8001","","別紙様式１１-１（病院）","保険医療機関名",1,"",0,101,"","","1100","8001","テスト",6,"M","medInstName"]
["1100","8002","","別紙様式１１-１（病院）","医療機関コード",1,1,0,7,"1.桁数チェック","DCM","1100","8002","0123456",7,"M","nochange"]
["1100","8003","","別紙様式１１-１（病院）","別添1の「第14の2」の1に規定する在宅療養支援病院の区分",1,"","","","2.入力内容チェック","AG","1100","8003","",9,"E",""]
["1100","8005","","別紙様式１１-１（病院）","Ⅰ.直近1年間に在宅療養を担当した患者について-平均診療期間","",1,0,5,"","","1100","8005","",14,"O",""]
["1100","8006","","別紙様式１１-１（病院）","Ⅰ.直近1年間に在宅療養を担当した患者について-合計診療患者数","",1,0,8,"","","1100","8006","",15,"O",""]
["1100","8007","","別紙様式１１-１（病院）","Ⅰ.直近1年間に在宅療養を担当した患者について-【再掲】死亡患者数","",1,0,9,"","","1100","8007","225",16,"O","nochange"]
["1100","8008","","別紙様式１１-１（病院）","Ⅰ.直近1年間に在宅療養を担当した患者について-（１）うち医療機関以外での死亡者数","",1,0,9,"","","1100","8008","190",17,"O","nochange"]
["1100","8009","","別紙様式１１-１（病院）","Ⅰ.直近1年間に在宅療養を担当した患者について-ア　うち自宅での死亡者数","",1,0,8,"","","1100","8009","",18,"O",""]
["1100","8010","","別紙様式１１-１（病院）","Ⅰ.直近1年間に在宅療養を担当した患者について-イ　うち自宅以外での死亡者数","",1,0,8,"","","1100","8010","",19,"O",""]
["1100","8011","","別紙様式１１-１（病院）","Ⅰ.直近1年間に在宅療養を担当した患者について-（２）うち医療機関での死亡者数","",1,0,9,"","","1100","8011","35",20,"O","nochange"]
["1100","8012","","別紙様式１１-１（病院）","Ⅰ.直近1年間に在宅療養を担当した患者について-ア　うち連携医療機関での死亡者数","",1,0,8,"","","1100","8012","",21,"O",""]
["1100","8013","","別紙様式１１-１（病院）","Ⅰ.直近1年間に在宅療養を担当した患者について-イ　うち連携医療機関以外での死亡者数","",1,0,8,"","","1100","8013","",22,"O",""]
["1100","8014","","別紙様式１１-１（病院）","Ⅰ.直近1年間に在宅療養を担当した患者について-超重症児又は準超重症児の患者数","",1,0,8,"","","1100","8014","",23,"O",""]
["1100","8015","","別紙様式１１-１（病院）","Ⅱ直近1年間の訪問診療等の実施回数について-訪問診療等の合計回数","",1,0,9,"","","1100","8015","350",32,"B","nochange"]
["1100","8016","","別紙様式１１-１（病院）","Ⅱ直近1年間の訪問診療等の実施回数について-（１）往診","",1,0,8,"3.入力内容チェック","","1100","8016","",32,"G",""]
["1100","8017","","別紙様式１１-１（病院）","Ⅱ直近1年間の訪問診療等の実施回数について-（１）往診-【再掲】うち緊急の往診","",1,0,8,"3.入力内容チェック","AH","1100","8017","",32,"J",""]
["1100","8018","","別紙様式１１-１（病院）","Ⅱ直近1年間の訪問診療等の実施回数について-（２）訪問診療","",1,0,8,"","","1100","8018","",32,"M",""]
["1100","8019","","別紙様式１１-１（病院）","Ⅱ直近1年間の訪問診療等の実施回数について-（３）訪問看護（緊急を含む）","",1,0,8,"","","1100","8019","",32,"P",""]
["1100","8020","","別紙様式１１-１（病院）","Ⅲ.在宅支援連携体制について-在宅医療を担当する常勤の医師数","",1,0,4,"2.入力内容チェック","","1100","8020","",39,"K",""]
["1100","8021","","別紙様式１１-１（病院）","Ⅲ.在宅支援連携体制について-連携する保険医療機関数","",1,0,5,"2.入力内容チェック","","1100","8021","",40,"K",""]
["1114","0001","","別紙様式１１-２（診療所）","保険医療機関名",1,"",0,101,"","","1114","0001","テスト",6,"M","medInstName"]
["1114","0002","","別紙様式１１-２（診療所）","医療機関コード",1,1,0,7,"1.桁数チェック","DCM","1114","0002","0123456",7,"M","nochange"]
["1114","0003","","別紙様式１１-２（診療所）","Ⅰ.直近1年間に在宅療養を担当した患者について-平均診療期間","",1,0,5,"","","1114","0003","",12,"O",""]
["1114","0004","","別紙様式１１-２（診療所）","Ⅰ.直近1年間に在宅療養を担当した患者について-合計診療患者数","",1,0,8,"","","1114","0004","",13,"O",""]
["1114","0005","","別紙様式１１-２（診療所）","Ⅰ.直近1年間に在宅療養を担当した患者について-【再掲】死亡患者数","",1,0,9,"","","1114","0005","112",14,"O","nochange"]
["1114","0006","","別紙様式１１-２（診療所）","Ⅰ.直近1年間に在宅療養を担当した患者について-（１）うち医療機関以外での死亡者数","",1,0,9,"","","1114","0006","52",15,"O","nochange"]
["1114","0007","","別紙様式１１-２（診療所）","Ⅰ.直近1年間に在宅療養を担当した患者について-ア　うち自宅での死亡者数","",1,0,8,"","","1114","0007","",16,"O",""]
["1114","0008","","別紙様式１１-２（診療所）","Ⅰ.直近1年間に在宅療養を担当した患者について-イ　うち自宅以外での死亡者数","",1,0,8,"","","1114","0008","",17,"O",""]
["1114","0009","","別紙様式１１-２（診療所）","Ⅰ.直近1年間に在宅療養を担当した患者について-（２）うち医療機関での死亡者数","",1,0,9,"","","1114","0009","60",18,"O","nochange"]
["1114","0010","","別紙様式１１-２（診療所）","Ⅰ.直近1年間に在宅療養を担当した患者について-ア　うち連携医療機関での死亡者数","",1,0,8,"","","1114","0010","",19,"O",""]
["1114","0011","","別紙様式１１-２（診療所）","Ⅰ.直近1年間に在宅療養を担当した患者について-イ　うち連携医療機関以外での死亡者数","",1,0,8,"","","1114","0011","",20,"O",""]
["1114","0012","","別紙様式１１-２（診療所）","Ⅱ直近1年間の訪問診療等の実施回数について-訪問診療等の合計回数","",1,0,9,"","","1114","0012","1110",29,"B","nochange"]
["1114","0013","","別紙様式１１-２（診療所）","Ⅱ直近1年間の訪問診療等の実施回数について-（１）往診","",1,0,8,"3.入力内容チェック","","1114","0013","",29,"G",""]
["1114","0014","",{"$f":"IF(AND(A1768=\"0600\",LEFT(B1768,1)=\"0\"),VLOOKUP(\"0601\",SheetName,2,FALSE),IF(AND(A1768=\"0600\",LEFT(B1768,1)=\"1\"),VLOOKUP(\"0602\",SheetName,2,FALSE),IF(AND(A1768=\"1100\",LEFT(B1768,1)=\"7\"),VLOOKUP(\"1113\",SheetName,2,FALSE),IF(AND(A1768=\"1100\",LEFT(B1768,1)=\"8\"),VLOOKUP(\"1123\",SheetName,2,FALSE),VLOOKUP(A1768,SheetName,2,FALSE)))))","v":"別紙様式１１-２（診療所）"},"Ⅱ直近1年間の訪問診療等の実施回数について-（１）往診-【再掲】うち緊急の往診","",1,0,8,"3.入力内容チェック","A","1114","0014","",29,"J",""]
["1114","0015","","別紙様式１１-２（診療所）","Ⅱ直近1年間の訪問診療等の実施回数について-（２）訪問診療","",1,0,8,"","","1114","0015","",29,"M",""]
["1114","0016","","別紙様式１１-２（診療所）","Ⅱ直近1年間の訪問診療等の実施回数について-（３）訪問看護（緊急を含む）","",1,0,8,"","","1114","0016","",29,"P",""]
["1114","0017","","別紙様式１１-２（診療所）","Ⅲ.在宅支援連携体制について-在宅医療を担当する常勤の医師数","",1,0,4,"","","1114","0017","",34,"K",""]
["1114","0018","","別紙様式１１-２（診療所）","Ⅲ.在宅支援連携体制について-連携する保険医療機関数","",1,0,5,"","","1114","0018","",35,"K",""]
["1114","0019","","別紙様式１１-２（診療所）","Ⅳ.在宅支援連携体制を構築している連携保険医療機関名1","","",0,101,"2.外字チェック","","1114","0019","",38,"B",""]
["1114","0020","","別紙様式１１-２（診療所）","Ⅳ.在宅支援連携体制を構築している連携保険医療機関名2","","",0,101,"2.外字チェック","","1114","0020","",38,"H",""]
["1114","0021","","別紙様式１１-２（診療所）","Ⅳ.在宅支援連携体制を構築している連携保険医療機関名3","","",0,101,"2.外字チェック","","1114","0021","",38,"M",""]
["1114","0022","","別紙様式１１-２（診療所）","Ⅳ.在宅支援連携体制を構築している連携保険医療機関名4","","",0,101,"2.外字チェック","","1114","0022","",39,"B",""]
["1114","0023","","別紙様式１１-２（診療所）","Ⅳ.在宅支援連携体制を構築している連携保険医療機関名5","","",0,101,"2.外字チェック","","1114","0023","",39,"H",""]
["1114","0024","","別紙様式１１-２（診療所）","Ⅳ.在宅支援連携体制を構築している連携保険医療機関名6","","",0,101,"2.外字チェック","","1114","0024","",39,"M",""]
["1114","0025","","別紙様式１１-２（診療所）","Ⅳ.在宅支援連携体制を構築している連携保険医療機関名7","","",0,101,"2.外字チェック","","1114","0025","",40,"B",""]
["1114","0026","","別紙様式１１-２（診療所）","Ⅳ.在宅支援連携体制を構築している連携保険医療機関名8","","",0,101,"2.外字チェック","","1114","0026","",40,"H",""]
["1114","0027","","別紙様式１１-２（診療所）","Ⅳ.在宅支援連携体制を構築している連携保険医療機関名9","","",0,101,"2.外字チェック","","1114","0027","",40,"M","",null,"",""]
["1124","0001","","別紙様式１１-２（病院）","保険医療機関名",1,"",0,101,"","","1124","0001","テスト",6,"M","medInstName",null,"",""]
["1124","0002","","別紙様式１１-２（病院）","医療機関コード",1,1,0,7,"1.桁数チェック","DCM","1124","0002","0123456",7,"M","nochange",null,"",""]
["1124","0003","","別紙様式１１-２（病院）","Ⅰ.直近1年間に在宅療養を担当した患者について-平均診療期間","",1,0,5,"","","1124","0003","",12,"O","",null,"",""]
["1124","0004","","別紙様式１１-２（病院）","Ⅰ.直近1年間に在宅療養を担当した患者について-合計診療患者数","",1,0,8,"","","1124","0004","",13,"O","",null,"",""]
["1124","0005","","別紙様式１１-２（病院）","Ⅰ.直近1年間に在宅療養を担当した患者について-【再掲】死亡患者数","",1,0,9,"","","1124","0005","186",14,"O","nochange",null,"",""]
["1124","0006","","別紙様式１１-２（病院）","Ⅰ.直近1年間に在宅療養を担当した患者について-（１）うち医療機関以外での死亡者数","",1,0,9,"","","1124","0006","88",15,"O","nochange",null,"",""]
["1124","0007","","別紙様式１１-２（病院）","Ⅰ.直近1年間に在宅療養を担当した患者について-ア　うち自宅での死亡者数","",1,0,8,"","","1124","0007","",16,"O","",null,"",""]
["1124","0008","","別紙様式１１-２（病院）","Ⅰ.直近1年間に在宅療養を担当した患者について-イ　うち自宅以外での死亡者数","",1,0,8,"","","1124","0008","",17,"O","",null,"",""]
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["2100","0054","","別紙様式２１","3.精神保健指定医に係る要件-（２）精神保健福祉法上の精神保健指定医として業務等を年１回以上行っていること。-実施日-実施医療機関名1","","",0,101,"2.外字チェック","","2100","0054","",48,"H","",null,"","-"]
["2100","0055","","別紙様式２１","3.精神保健指定医に係る要件-（２）精神保健福祉法上の精神保健指定医として業務等を年１回以上行っていること。-実施日-実施日2","","",0,11,"3.入力内容チェック","A","2100","0055","",48,"J","",null,"","-"]
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["2100","0058","","別紙様式２１","3.精神保健指定医に係る要件-（２）精神保健福祉法上の精神保健指定医として業務等を年１回以上行っていること。-公務員としての業務の場合-①実施した業務の内容2","","",0,100,"2.外字チェック","","2100","0058","",50,"J","",null,"","-"]
["2100","0059","","別紙様式２１","3.精神保健指定医に係る要件-（２）精神保健福祉法上の精神保健指定医として業務等を年１回以上行っていること。-公務員としての業務の場合-②依頼元（都道府県名等）1","","",0,50,"2.外字チェック","","2100","0059","",51,"G","",null,"","-"]
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["2500","0030","","別紙様式２５","他医療機関で時間外、休日又は深夜における外来対応施設での外来診療又は救急医療機関で診療協力（外来、当直、対診等）を年６回以上行うこと（いずれも精神科医療を必要とする患者の診療を行うこと。）。-実施日⑥（実施医療機関名）-実施医療機関名1","","",0,101,"","","2500","0030","",21,"I","",null,"","-"]
["2500","0031","","別紙様式２５","他医療機関で時間外、休日又は深夜における外来対応施設での外来診療又は救急医療機関で診療協力（外来、当直、対診等）を年６回以上行うこと（いずれも精神科医療を必要とする患者の診療を行うこと。）。-実施日⑥（実施医療機関名）-実施日2","","",0,11,"4.入力内容チェック","B","2500","0031","",21,"L","",null,"","-"]
["2500","0032","","別紙様式２５","他医療機関で時間外、休日又は深夜における外来対応施設での外来診療又は救急医療機関で診療協力（外来、当直、対診等）を年６回以上行うこと（いずれも精神科医療を必要とする患者の診療を行うこと。）。-実施日⑥（実施医療機関名）-実施医療機関名2","","",0,101,"","","2500","0032","",21,"N","",null,"","-"]
["2500","0033","","別紙様式２５","精神保健福祉法上の精神保健指定医として業務等（※）を年１回以上行っていること。（※）精神保健福祉法第十九条の四に規定する業務等を指す。-実施日（実施医療機関名）-実施日1","","",0,11,"4.入力内容チェック","B","2500","0033","",23,"G","",null,"","-"]
["2500","0034","","別紙様式２５","精神保健福祉法上の精神保健指定医として業務等（※）を年１回以上行っていること。（※）精神保健福祉法第十九条の四に規定する業務等を指す。-実施日（実施医療機関名）-実施医療機関名1","","",0,101,"","","2500","0034","",23,"I","",null,"","-"]
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["2500","0058","","別紙様式２５","市町村又は特別区名2","","",0,50,"","","2500","0058","",39,"B","",null,"","-"]
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["2500","0062","","別紙様式２５","市町村又は特別区名4","","",0,50,"","","2500","0062","",41,"B","",null,"","-"]
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["2500","0064","","別紙様式２５","市町村又は特別区名5","","",0,50,"","","2500","0064","",42,"B","",null,"","-"]
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["2500","0066","","別紙様式２５","市町村又は特別区名6","","",0,50,"","","2500","0066","",43,"B","",null,"","-"]
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["2500","0070","","別紙様式２５","市町村又は特別区名8","","",0,50,"","","2500","0070","",45,"B","",null,"","-"]
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["2500","0072","","別紙様式２５","市町村又は特別区名9","","",0,50,"","","2500","0072","",46,"B","",null,"","-"]
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["2500","0076","","別紙様式２５","市町村又は特別区名11","","",0,50,"","","2500","0076","",48,"B","",null,"","-"]
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["02","02:青森県","青森県","医科（有床診療所）","2","2　国立病院機構","1-2","1-2：急性期一般入院料２","1-2","1-2：急性期一般入院料２","B","B：40％以上70％未満","2","②看護必要度加算２","2","2：25対１急性期看護補助体制加算（看護補助者５割以上）","B","B：26人以上51人未満","2","2：看護職員夜間12対１配置加算１","2","2：夜間30対１急性期看護補助体制加算","2","2：急性期看護補助体制加算","2","2：勤務開始時刻が、直近の勤務の開始時刻の概ね24時間後以降","2","2","2：救命救急入院料２","昭和",1926,"1926-12-25","1989-01-07",null,"2","２　医科（有床診療所）",null,"0103","別紙様式１-３",null,null,null,"2","②地域一般入院基本料","11","⑪療養病棟入院料２","2","２：急性期一般入院料２","急性期一般入院基本料（入院料２）",null,2,"2：要支援２",2,"2：廃用症候群",2,"2：3か月以上6か月未満",null,null,null,"ハイケアユニット入院医療管理料",null,null,"注９",null,null,3,null,null,2,"２．10人以上20人未満",null,2,"２．1日2回",null,"挿入器付後房レンズ"]
["03","03:岩手県","岩手県","医科（無床診療所）","3","3　国立大学法人","1-3","1-3：急性期一般入院料３","1-3","1-3：急性期一般入院料３","C","C：20%以上40％未満","3","③看護必要度加算３","3","3：25対１急性期看護補助体制加算（看護補助者５割未満）","C","C：51人以上76人未満","3","3：看護職員夜間12対１配置加算２","3","3：夜間50対１急性期看護補助体制加算","3","3：看護補助加算","3","3：夜勤の連続回数が２回以下","3","3","3：救命救急入院料３","平成",1989,"1989-04-08","2019-04-30",null,"3","３　医科（無床診療所）",null,"0200","別紙様式２",null,null,null,"3","③７対１入院基本料","12","⑫療養病棟入院基本料の注11の病棟","3","３：急性期一般入院料３","急性期一般入院基本料（入院料３）",null,3,"3：要介護１",3,"3：外傷",3,"3：6か月以上1年未満",null,null,null,"脳卒中ケアユニット入院医療管理料",null,null,null,null,null,4,null,null,3,"３．20人以上30人未満",null,3,"３．1日3回以上5回未満"]
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["06","06:山形県","山形県",null,"6","6　その他（国）","1-6","1-6：急性期一般入院料６","1-6","1-6：急性期一般入院料６",null,null,null,null,"6","6：看護補助加算１（30対１）","F","F：配置なし","6","6：看護職員夜間配置加算（地域包括ケア病棟入院料、精神科救急急性期医療入院料、精神科救急・合併症入院料）","6","6：夜間30対1看護補助体制加算",null,null,"6","6：業務量の把握・部署間支援",null,"6","6：特定集中治療室管理料２",null,null,null,null,null,null,null,null,"0402","別紙様式４-２",null,null,null,null,null,null,null,"6","６：急性期一般入院料６","急性期一般入院基本料（入院料６）",null,6,"6：要介護４",null,null,null,null,null,null,null,null,null,null,null,null,null,7,null,null,6,"６．50人以上"]
["07","07:福島県","福島県",null,"7","7　都道府県","2-1","2-1：地域一般入院料１","2-1","2-1：地域一般入院料１",null,null,null,null,"7","7：看護補助加算２（50対１）",null,null,null,null,"7","7：夜間50対1看護補助体制加算",null,null,"7","7：看護補助者の業務の５割以上が療養上の世話",null,"7","7：特定集中治療室管理料３",null,null,null,null,null,null,null,null,"0500","別紙様式５",null,null,null,null,null,null,null,"7","７：急性期一般入院料７","地域一般入院基本料（入院料１）",null,7,"7：要介護５"]
["08","08:茨城県","茨城県",null,"8","8　市町村","2-2","2-2：地域一般入院料２","3-1","3-1：特定機能病院入院基本料（一般病棟）の７対１入院基本料",null,null,null,null,"8","8：看護補助加算３（75対１）",null,null,null,null,"8","8：夜間100対1看護補助体制加算",null,null,"8","8：看護補助者の夜間配置",null,"8","8：特定集中治療室管理料４",null,null,null,null,null,null,null,null,"0601","別紙様式６（１枚目）",null,null,null,null,null,null,null,"8","８：地域一般入院料１","地域一般入院基本料（入院料２）",null,8,"8：該当なし"]
["09","09:栃木県","栃木県",null,"9","9　地方独立行政法人","2-3","2-3：地域一般入院料３","3-2","3-2：特定機能病院入院基本料（結核病棟）の７対１入院基本料",null,null,null,null,"9","9：看護補助加算（障害者施設等入院基本料）/看護補助体制充実加算（障害者施設等入院基本料）",null,null,null,null,null,null,null,null,"9","9：看護補助者比率５割以上",null,"9","9：特定集中治療室管理料５",null,null,null,null,null,null,null,null,"0602","別紙様式６（２枚目）",null,null,null,null,null,null,null,"9","９：地域一般入院料２","地域一般入院基本料（入院料３）"]
["10","10:群馬県","群馬県",null,"10","10　日赤","3","3：７対１入院基本料","3-3","3-3：専門病院入院基本料の７対１入院基本料",null,null,null,null,"10","10：25対１看護補助体制加算（看護補助者５割以上）",null,null,null,null,null,null,null,null,"10","10：夜間院内保育所の設置・利用実績",null,"10","10：特定集中治療室管理料６",null,null,null,null,null,null,null,null,"0700","別紙様式７",null,null,null,null,null,null,null,"10","１０：地域一般入院料３","療養病棟入院基本料（入院料１）"]
["11","11:埼玉県","埼玉県",null,"11","11　済生会","4","4：10対１入院基本料","3-4","3-4：結核病棟の７対１入院基本料",null,null,null,null,"11","11：25対１看護補助体制加算（看護補助者５割未満）",null,null,null,null,null,null,null,null,"11","11：ICT、AI、IoT等の活用による業務負担軽減",null,"11","11：ハイケアユニット入院医療管理料１",null,null,null,null,null,null,null,null,"0800","別紙様式８",null,null,null,null,null,null,null,"11","１１：特別入院基本料","療養病棟入院基本料（入院料２）"]
["12","12:千葉県","千葉県",null,"12","12　北海道社会事業協会","5","5：13対１入院基本料","4-1","4-1：特定機能病院入院基本料（一般病棟）の10対１入院基本料",null,null,null,null,"12","12：50対１看護補助体制加算",null,null,null,null,null,null,null,null,null,null,null,"12","12：ハイケアユニット入院医療管理料２",null,null,null,null,null,null,null,null,"0900","別紙様式９",null,null,null,null,null,null,null,"12","１２：月平均夜勤時間超過減算","結核病棟入院基本料（７対１）"]
["13","13:東京都","東京都",null,"13","13　厚生連","6","6：15対１入院基本料","4-2","4-2：専門病院入院基本料の10対１入院基本料",null,null,null,null,"13","13：75対１看護補助体制加算",null,null,null,null,null,null,null,null,null,null,null,"13","13：脳卒中ケアユニット入院医療管理料",null,null,null,null,null,null,null,null,"1000","別紙様式１０",null,null,null,null,null,null,null,"13","１３：夜勤時間特別入院基本料","結核病棟入院基本料（10対１）"]
["14","14:神奈川県","神奈川県",null,"14","14　国民健康保険団体連合会","7","7：18対１入院基本料","5","5：専門病院入院基本料の13対１入院基本料",null,null,null,null,"14","14：看護補助加算（小児入院医療管理料）/看護補助体制充実加算（小児入院医療管理料）",null,null,null,null,null,null,null,null,null,null,null,"14","14：小児特定集中治療室管理料",null,null,null,null,null,null,null,null,"1113","別紙様式１１-１（診療所）",null,null,null,null,null,null,null,"14","１４：７対１入院基本料","結核病棟入院基本料（13対１）"]
["15","15:新潟県","新潟県",null,"15","15　健康保険組合及びその連合会","8","8：20対１入院基本料",null,null,null,null,null,null,"15","15：看護補助者配置加算（地域包括ケア病棟入院料）/看護補助体制充実加算",null,null,null,null,null,null,null,null,null,null,null,"15","15：新生児特定集中治療室管理料１",null,null,null,null,null,null,null,null,"1123","別紙様式１１-１（病院）",null,null,null,null,null,null,null,"15","１５：１０対１入院基本料","結核病棟入院基本料（15対１）"]
["16","16:富山県","富山県",null,"16","16　共済組合及びその連合会","9","9：特別入院基本料（療養以外）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"16","16：新生児特定集中治療室管理料２",null,null,null,null,null,null,null,null,"1114","別紙様式１１-２（診療所）",null,null,null,null,null,null,null,"16","１６：１３対１入院基本料","結核病棟入院基本料（18対１）"]
["17","17:石川県","石川県",null,"17","17　国民健康保険組合","10","10：療養病棟入院料１",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"17","17：新生児特定集中治療室重症児対応体制強化管理料",null,null,null,null,null,null,null,null,"1124","別紙様式１１-２（病院）",null,null,null,null,null,null,null,null,null,"結核病棟入院基本料（20対１）"]
["18","18:福井県","福井県",null,"18","18　公益法人","11","11：療養病棟入院料２",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"18-1","18-1：総合周産期特定集中治療室管理料１（母体・胎児集中治療室管理料）",null,null,null,null,null,null,null,null,"1200","別紙様式１２",null,null,null,null,null,null,null,null,null,"精神病棟入院基本料（10対１）"]
["19","19:山梨県","山梨県",null,"19","19　医療法人","12","12：療養病棟入院基本料の注11の病棟",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"18-2","18-2：総合周産期特定集中治療室管理料２（新生児集中治療室管理料）",null,null,null,null,null,null,null,null,"1400","別紙様式１４",null,null,null,null,null,null,null,null,null,"精神病棟入院基本料（13対１）"]
["20","20:長野県","長野県",null,"20","20　学校法人","13","13：特別入院基本料（療養）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"19","19：新生児治療回復室入院医療管理料",null,null,null,null,null,null,null,null,"1500","別紙様式１５",null,null,null,null,null,null,null,null,null,"精神病棟入院基本料（15対１）"]
["21","21:岐阜県","岐阜県",null,"21","21　社会福祉法人","14","14：月平均夜勤時間超過減算",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"20","20：地域包括医療病棟入院料",null,null,null,null,null,null,null,null,"1600","別紙様式１６",null,null,null,null,null,null,null,null,null,"精神病棟入院基本料（18対１）"]
["22","22:静岡県","静岡県",null,"22","22　医療生協","15","15：夜勤時間特別入院基本料",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"21","21：一類感染症患者入院医療管理料",null,null,null,null,null,null,null,null,"1701","別紙様式１７の１",null,null,null,null,null,null,null,null,null,"精神病棟入院基本料（20対１）"]
["23","23:愛知県","愛知県",null,"23","23　会社","16","16：重症患者割合特別入院基本料",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"22","22：小児入院医療管理料１",null,null,null,null,null,null,null,null,"1702","別紙様式１７の２",null,null,null,null,null,null,null,null,null,"特定機能病院入院基本料（一般病棟・７対１）"]
["24","24:三重県","三重県",null,"24","24　その他の法人",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"23","23：小児入院医療管理料２",null,null,null,null,null,null,null,null,"1800","別紙様式１８",null,null,null,null,null,null,null,null,null,"特定機能病院入院基本料（一般病棟・10対１）"]
["25","25:滋賀県","滋賀県",null,"25","25　個人（個人名は記載しないこと）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"24","24：小児入院医療管理料３",null,null,null,null,null,null,null,null,"1900","別紙様式１９",null,null,null,null,null,null,null,null,null,"特定機能病院入院基本料（結核病棟・７対１）"]
["26","26:京都府","京都府",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"25","25：回復期リハビリテーション病棟入院料１",null,null,null,null,null,null,null,null,"2000","別紙様式２０",null,null,null,null,null,null,null,null,null,"特定機能病院入院基本料（結核病棟・10対１）"]
["27","27:大阪府","大阪府",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"26","26：回復期リハビリテーション病棟入院料２",null,null,null,null,null,null,null,null,"2100","別紙様式２１",null,null,null,null,null,null,null,null,null,"特定機能病院入院基本料（結核病棟・13対１）"]
["28","28:兵庫県","兵庫県",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"27","27：回復期リハビリテーション病棟入院料３",null,null,null,null,null,null,null,null,"2200","別紙様式２２",null,null,null,null,null,null,null,null,null,"特定機能病院入院基本料（結核病棟・15対１）"]
["29","29:奈良県","奈良県",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"28","28：回復期リハビリテーション病棟入院料４",null,null,null,null,null,null,null,null,"2300","別紙様式２３",null,null,null,null,null,null,null,null,null,"特定機能病院入院基本料（精神病棟・７対１）"]
["30","30:和歌山県","和歌山県",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"29","29：回復期リハビリテーション病棟入院料５",null,null,null,null,null,null,null,null,"2400","別紙様式２４",null,null,null,null,null,null,null,null,null,"特定機能病院入院基本料（精神病棟・10対１）"]
["31","31:鳥取県","鳥取県",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"30","30：地域包括ケア病棟入院料１",null,null,null,null,null,null,null,null,"2500","別紙様式２５",null,null,null,null,null,null,null,null,null,"特定機能病院入院基本料（精神病棟・13対１）"]
["32","32:島根県","島根県",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"31","31：地域包括ケア病棟入院料２",null,null,null,null,null,null,null,null,"2600","別紙様式２６",null,null,null,null,null,null,null,null,null,"特定機能病院入院基本料（精神病棟・15対１）"]
["33","33:岡山県","岡山県",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"32","32：地域包括ケア病棟入院料３",null,null,null,null,null,null,null,null,"2700","別紙様式２７",null,null,null,null,null,null,null,null,null,"専門病棟入院基本料（７対１）"]
["34","34:広島県","広島県",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"33","33：地域包括ケア病棟入院料４",null,null,null,null,null,null,null,null,"2800","別紙様式２８",null,null,null,null,null,null,null,null,null,"専門病棟入院基本料（10対１）"]
["35","35:山口県","山口県",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"34","34：特殊疾患病棟入院料１",null,null,null,null,null,null,null,null,"2900","別紙様式２９",null,null,null,null,null,null,null,null,null,"専門病棟入院基本料（13対１）"]
["36","36:徳島県","徳島県",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"35","35：特殊疾患病棟入院料２",null,null,null,null,null,null,null,null,"3000","別紙様式３０",null,null,null,null,null,null,null,null,null,"障害者施設等入院基本料（７対１）"]
["37","37:香川県","香川県",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"36","36：緩和ケア病棟入院料１",null,null,null,null,null,null,null,null,"3100","別紙様式３１",null,null,null,null,null,null,null,null,null,"障害者施設等入院基本料（10対１）"]
["38","38:愛媛県","愛媛県",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"37","37：緩和ケア病棟入院料２",null,null,null,null,null,null,null,null,"3200","別紙様式３２",null,null,null,null,null,null,null,null,null,"障害者施設等入院基本料（13対１）"]
["39","39:高知県","高知県",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"38","38：精神科救急急性期医療入院料",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"障害者施設等入院基本料（15対１）"]
["40","40:福岡県","福岡県",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"39","39：精神科急性期治療病棟入院料１",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有床診療所入院基本料１"]
["41","41:佐賀県","佐賀県",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"40","40：精神科急性期治療病棟入院料２",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有床診療所入院基本料２"]
["42","42:長崎県","長崎県",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"41","41：精神科救急・合併症入院料",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有床診療所入院基本料３"]
["43","43:熊本県","熊本県",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"42","42：児童・思春期精神科入院医療管理料",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有床診療所入院基本料４"]
["44","44:大分県","大分県",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"43","43：精神療養病棟入院料",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有床診療所入院基本料５"]
["45","45:宮崎県","宮崎県",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"44","44：認知症治療病棟入院料１",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有床診療所入院基本料６"]
["46","46:鹿児島県","鹿児島県",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"45","45：認知症治療病棟入院料２",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有床診療所療養病床入院基本料Ａ"]
["47","47:沖縄県","沖縄県",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"46","46：精神科地域包括ケア病棟入院料",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有床診療所療養病床入院基本料Ｂ"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"47","47：特定一般病棟入院料１",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有床診療所療養病床入院基本料Ｃ"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"48","48：特定一般病棟入院料２",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有床診療所療養病床入院基本料Ｄ"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"49","49：地域移行機能強化病棟入院料",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有床診療所療養病床入院基本料Ｅ"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"50","50：特定機能病院リハビリテーション病棟入院料",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"救命救急入院料１"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"救命救急入院料２"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"救命救急入院料３"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"救命救急入院料４"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"特定集中治療室管理料１"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"特定集中治療室管理料２"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"特定集中治療室管理料３"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"特定集中治療室管理料４"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"特定集中治療室管理料５"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"特定集中治療室管理料６"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ハイケアユニット入院医療管理料１"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ハイケアユニット入院医療管理料２"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"脳卒中ケアユニット入院医療管理料"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"小児特定集中治療室管理料"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"新生児特定集中治療室管理料１"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"新生児特定集中治療室管理料２"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"新生児特定集中治療室重症児対応体制強化管理料"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"総合周産期特定集中治療室管理料（母体・胎児集中治療室管理料）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"総合周産期特定集中治療室管理料（新生児集中治療室管理料）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"新生児治療回復室入院医療管理料"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"地域包括医療病棟入院料"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"一類感染症患者入院医療管理料"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"特殊疾患入院医療管理料"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"小児入院医療管理料１"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"小児入院医療管理料２"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"小児入院医療管理料３"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"小児入院医療管理料４"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"小児入院医療管理料５"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回復期リハビリテーション病棟入院料１"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回復期リハビリテーション病棟入院料２"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回復期リハビリテーション病棟入院料３"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回復期リハビリテーション病棟入院料４"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回復期リハビリテーション病棟入院料５"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回復期リハビリテーション入院医療管理料"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"地域包括ケア病棟入院料１"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"地域包括ケア入院医療管理料１"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"地域包括ケア病棟入院料２"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"地域包括ケア入院医療管理料２"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"地域包括ケア病棟入院料３"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"地域包括ケア入院医療管理料３"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"地域包括ケア病棟入院料４"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"地域包括ケア入院医療管理料４"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"特殊疾患病棟入院料１"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"特殊疾患病棟入院料２"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"緩和ケア病棟入院料１"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"緩和ケア病棟入院料２"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"精神科救急急性期医療入院料"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"精神科急性期治療病棟入院料１"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"精神科急性期治療病棟入院料２"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"精神科救急・合併症入院料"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"児童・思春期精神科入院医療管理料"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"精神療養病棟入院料"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"認知症治療病棟入院料１"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"認知症治療病棟入院料２"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"精神科地域包括ケア病棟入院料"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"特定一般病棟入院料１"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"特定一般病棟入院料２"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"地域移行機能強化病棟入院料"]

{"sheet":"別紙様式１-１","index":3,"n_rows":65,"n_cols":36,"rows_kept":65,"cut":false,"hidden":false,"merged":[[60,2,60,6],[61,2,61,6],[62,2,62,36],[63,2,63,34],[64,2,64,36],[54,2,54,6],[55,2,55,6],[56,2,56,6],[57,2,57,6],[58,2,58,6],[59,2,59,6],[48,2,48,6],[49,2,49,6],[50,2,50,6],[51,2,51,6],[52,2,52,6],[53,2,53,6],[38,35,40,35],[40,23,40,33],[41,0,61,0],[41,2,41,6],[42,2,42,6],[43,2,43,6],[44,2,44,6],[45,2,45,6],[46,2,46,6],[47,2,47,6],[38,19,39,19],[38,20,39,20],[38,21,39,21],[38,22,39,22],[38,23,39,33],[38,34,40,34],[38,13,39,13],[38,14,39,14],[38,15,39,15],[38,16,39,16],[38,17,39,17],[38,18,39,18],[35,2,35,16],[36,2,36,16],[36,27,36,28],[36,29,36,35],[37,24,37,26],[38,0,40,6],[38,7,39,7],[38,8,39,8],[38,9,39,9],[38,10,38,12],[31,2,31,36],[32,2,32,34],[33,2,33,36],[34,2,34,36],[27,2,27,4],[27,5,27,7],[28,2,28,4],[28,5,28,7],[29,2,29,4],[29,5,29,7],[22,0,30,0],[22,2,22,7],[23,2,23,7],[24,2,24,7],[25,2,25,4],[25,5,25,7],[26,2,26,6],[30,2,30,4],[30,5,30,7],[16,6,16,7],[17,2,17,5],[17,6,17,7],[18,2,19,5],[18,6,18,7],[19,6,19,7],[10,0,21,0],[10,2,13,5],[10,6,10,7],[11,6,11,7],[12,6,12,7],[13,6,13,7],[14,2,14,5],[14,6,14,7],[15,2,16,5],[15,6,15,7],[20,2,21,5],[20,6,20,7],[21,6,21,7],[7,21,8,21],[7,22,8,22],[7,23,8,23],[7,24,8,34],[7,35,9,35],[9,24,9,34],[7,14,8,14],[7,15,8,15],[7,16,8,16],[7,17,8,17],[7,18,8,18],[7,19,8,19],[4,0,6,0],[4,1,6,10],[4,11,6,11],[4,12,6,15],[4,16,6,16],[4,17,6,20],[7,0,9,5],[7,6,8,7],[7,8,8,8],[7,9,8,9],[7,10,8,10],[7,11,7,13],[9,6,9,7],[7,20,8,20],[0,2,0,36],[1,2,1,16],[2,2,2,16],[2,27,2,28],[2,29,2,35],[3,24,3,26],[4,24,6,24],[4,25,6,29],[4,30,6,32],[4,33,6,35],[4,21,6,21],[4,22,6,23]]}
[null,null,"入院基本料等に関する実施状況報告書（令和６年８月１日現在）"]
["\n",null,"※　本様式の書式は変えないこと。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"受付番号※",null,null,null,null,null,"※地方厚生（支）局記載　　"]
[null,null,"※　印刷は片面印刷とすること。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"都道府県番号",null,"医療機関コード７桁"]
["（別紙様式１－１①）　【病院記入用】",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保険医療機関番号",null,null,{"$f":"IF(data!B1=\"\", \"\", LEFT(data!B1,1))","v":""},{"$f":"IF(data!B1=\"\", \"\", RIGHT(data!B1, 1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,1,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,2,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,3,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,4,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,5,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,6,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,7,1))","v":""}]
["医療機関名",{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""},null,null,null,null,null,null,null,null,null,"病院区分",null,null,null,null,"開設者番号",{"$f":"IF(data!R6=0,\"\",INDEX(list!E2:E27,data!R6))","v":""},null,null,null,"都道府県名",{"$f":"IF(data!B1=\"\",\"\",VLOOKUP(data!B1,list!A3:C49,3,FALSE))","v":""},null,"郡市区町村名",null,null,null,null,null,"厚生労働大臣が\n定める地域 \n(該当地域は☑を付すこと)",null,null,false]
[]
[]
[null,null,null,null,null,null,"届出区分",null,"看護師比率区分","平均在院日数（日）","在宅復帰率（％）","本来の届出",null,null,"稼働病床数（床）","１日平均入院患者数（人）","月平均1日看護職員\n配置数（人）","夜勤時間帯の看護職員１人当たりの患者数（人）","月平均1日看護補助者\n配置数（人）","夜勤時間帯の\n看護補助者１人当たり\nの患者数（人）","看護補助者の配置に係る加算","看護補助者の夜間配置に係る加算","看護職員の夜間配置に係る加算","夜間看護体制加算","夜間における看護業務の負担軽減に資する業務管理等に関する項目\n（夜間看護体制の評価にかかる加算の届出をしている場合に記載）",null,null,null,null,null,null,null,null,null,null,"新型コロナ臨時的な取扱いに関する報告の提出"]
[null,null,null,null,null,null,null,null,null,null,null,"病棟数（棟）","許可病床数（床）","医療保険届出病床数（床）"]
[null,null,null,null,null,null,"①～⑯\n記載上の注意\n項番４参照",null,"A～D\n記載上の\n注意項番５参照","小数点以下切り上げ\n※１","小数点第一位まで\n※１","整数","整数\n※２","整数\n※２","整数","１人未満端数切り上げ\n※３","小数点第一位まで\n※３","小数点第一位まで\n※３","小数点第一位まで\n※３","小数点第一位まで\n※３","①～⑮\n記載上の\n注意項番14参照","①～⑧\n記載上の\n注意項番15参照","①～⑥\n記載上の\n注意項番1６参照","①～⑤\n記載上の\n注意項番1７参照","①～⑪のうちすべて記載\n記載上の注意項番18参照"]
["入院基本料",1,"　一般病棟",null,null,null,"",null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false]
[null,2,null,null,null,null,"",null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false]
[null,3,null,null,null,null,"",null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false]
[null,4,null,null,null,null,"感染症病床\n（二類）",null,null,null,null,"","","",""]
[null,5,"　療養病棟",null,null,null,"",null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,6,"　結核病棟",null,null,null,"",null,"",null,null,null,null,null,null,null,null,null,null,null,"","",null,"","","","","","","","","","","","",false]
[null,7,null,null,null,null,"感染症病床\n（二類）",null,null,null,null,"","","",""]
[null,8,"　※患者数３０名以下で結核病床が一般病棟等\n　　に含まれている場合、結核病床のみを再掲",null,null,null,"",null,null,null,null,"","","",""]
[null,9,"　精神病棟",null,null,null,"",null,"",null,null,null,null,null,null,null,null,null,null,null,"","",null,"","","","","","","","","","","","",false]
[null,10,null,null,null,null,"感染症病床\n（二類）",null,null,null,null,"","","",""]
[null,11,"　障害者施設等",null,null,null,"",null,"",null,null,null,null,null,null,null,null,null,null,null,"","",null,"","","","","","","","","","","","",false]
[null,12,null,null,null,null,"感染症病床\n（二類）",null,null,null,null,"","","",""]
["特定入院料に係る病床",13,"特殊疾患入院医療管理料",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,14,"小児入院医療管理料３（※患者数概ね３０名以下で一般病棟等に含まれている場合、小児入院医療管理料３のみを再掲）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,15,"小児入院医療管理料４",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,16,"　小児入院医療管理料５",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,17,"　回復期リハビリテーション入院医療管理料",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,18,"　地域包括ケア入院医療管理料１",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,19,"　地域包括ケア入院医療管理料２",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,20,"　地域包括ケア入院医療管理料３",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,21,"　地域包括ケア入院医療管理料４",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,null,"※１　「平均在院日数」は小数点以下は切り上げること。「在宅復帰率」は小数点第一位までの実数（小数点第二位切り捨て）を記載すること。"]
[null,null,"※２　入院基本料の病床数には、特殊疾患入院医療管理料、小児入院医療管理料３（患者数概ね３０名以下で一般病棟等に含まれている場合）・４・５、回復期リハビリテーション入院医療管理料及び地域包括ケア入院医療管理料１～４に係る病床数を含めて記載し、その他の特定入院料に係る病床数は含めないこと。本様式の記入に際しては、医療法の許可病床を含め特に指定のない場合、全ての事項において医療保険適用病棟・病床についてのみ記入すること。"]
[null,null,"※３　「１日平均入院患者数」は１人未満の端数は、切り上げること。\n　　　「月平均１日看護職員配置数」、「夜勤時間帯の看護職員１人当たりの患者数」、「月平均１日看護補助者配置数」、「夜勤時間帯の看護補助者１人当たりの患者数」、は小数点第一位までの実数（小数点第二位切り捨て）を記載すること。"]
[null,null,"入院基本料等に関する実施状況報告書（令和６年８月１日現在）"]
[null,null,"※　本様式の書式は変えないこと。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"受付番号※",null,null,null,null,null,"※地方厚生（支）局記載　　"]
[null,null,"※　印刷は片面印刷とすること。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"都道府県番号",null,"医療機関コード７桁"]
["（別紙様式１－１②）　【病院記入用】",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保険医療機関番号",null,null,{"$f":"IF(AB4=\"\",\"\",AB4)","v":""},{"$f":"IF(AC4=\"\",\"\",AC4)","v":""},"","","","","","",""]
["届出区分",null,null,null,null,null,null,"看護師比率区分","平均在院日数（日）","在宅復帰率（％）","本来の届出",null,null,"稼働病床数（床）","１日平均入院患者数（人）","月平均1日看護職員配置数（人）","夜勤時間帯の看護職員１人当たりの患者数（人）","月平均1日看護補助者配置数（人）","夜勤時間帯の看護補助者１人当たりの患者数（人）","看護補助者の配置に係る加算","看護補助者の夜間配置に係る加算","看護職員の夜間配置に係る加算","夜間看護体制加算","夜間における看護業務の負担軽減に資する業務管理等に関する項目\n（夜間看護体制の評価にかかる加算の届出をしている場合に記載）",null,null,null,null,null,null,null,null,null,null,"新型コロナ臨時的な取扱いに関する報告の提出","宿日直を行う医師ではない医師が常時勤務"]
[null,null,null,null,null,null,null,null,null,null,"病棟数（棟）","許可病床数（床）","医療保険届出病床数（床）"]
[null,null,null,null,null,null,null,"A～D\n記載上の\n注意項番６参照","小数点以下切り上げ\n※１","小数点第一位まで\n※１","整数","整数\n※２","整数\n※２","整数","１人未満端数切り上げ\n※３","小数点第一位まで\n※３","小数点第一位まで\n※３","小数点第一位まで\n※３","小数点第一位まで\n※３","①～⑭\n記載上の\n注意項番14参照","①～⑧\n記載上の\n注意項番15参照","①～⑥\n記載上の\n注意項番1６参照","①～⑤\n記載上の\n注意項番1７参照","①～⑪のうちすべて記載\n記載上の注意項番18参照"]
["特定入院料に係る病棟等",22,"",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false,false]
[null,23,"",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false,false]
[null,24,"",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false,false]
[null,25,"",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false,false]
[null,26,"",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false,false]
[null,27,"",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false,false]
[null,28,"",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false,false]
[null,29,"",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false,false]
[null,30,"",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false,false]
[null,31,"",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false,false]
[null,32,"",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false,false]
[null,33,"",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false,false]
[null,34,"",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false,false]
[null,35,"",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false,false]
[null,36,"",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false,false]
[null,37,"",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false,false]
[null,38,"",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false,false]
[null,39,"",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false,false]
[null,40,"",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false,false]
[null,41,"",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false,false]
[null,42,"",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","",false,false]
[null,null,"※１　「平均在院日数」は小数点以下は切り上げること。「在宅復帰率」は小数点第一位までの実数（小数点第二位切り捨て）を記載すること。"]
[null,null,"※２　入院基本料の病床数には、特殊疾患入院医療管理料、小児入院医療管理料３（患者数概ね３０名以下で一般病棟等に含まれている場合）・４・５、回復期リハビリテーション入院医療管理料及び地域包括ケア入院医療管理料１～４に係る病床数を含めて記載し、その他の特定入院料に係る病床数は含めないこと。本様式の記入に際しては、医療法の許可病床を含め特に指定のない場合、全ての事項において医療保険適用病棟・病床についてのみ記入すること。"]
[null,null,"※３　「１日平均入院患者数」は１人未満の端数は、切り上げること。\n　　　「月平均１日看護職員配置数」、「夜勤時間帯の看護職員１人当たりの患者数」、「月平均１日看護補助者配置数」、「夜勤時間帯の看護補助者１人当たりの患者数」、は小数点第一位までの実数（小数点第二位切り捨て）を記載すること。"]

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["入院基本料等に関する実施状況報告書（令和６年８月１日現在）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"受付番号※",null,null,null,"※地方厚生（支）局記載　　"]
["（別紙様式１－２）【病院記入用】",null,null,null,null,null,null,null,null,null,"都道府県番号",null,"医療機関コード７桁"]
["※　本様式の書式は変えないこと。",null,null,null,null,null,"保険医療機関番号",null,null,null,{"$f":"IF(data!B1=\"\", \"\", LEFT(data!B1,1))","v":""},{"$f":"IF(data!B1=\"\", \"\", RIGHT(data!B1, 1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,1,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,2,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,3,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,4,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,5,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,6,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,7,1))","v":""}]
[]
[]
[null,"【届出区分１】"]
[null,"一般病棟",null,null,null,null,null,null,null,null,"結核病棟\n※一般病棟と結核病棟を併せて１看護単位とする場合を除く。"]
[null,"令和６年８月１日現在の届出区分",null,null,null,null,"",null,null,null,"令和６年８月１日現在の届出区分",null,null,null,null,""]
[null,"看護必要度加算・\n一般病棟看護必要度評価加算",null,null,null,null,"",null,null,null,"看護必要度加算・\n一般病棟看護必要度評価加算"]
[null,"重症度、医療・看護必要度の評価票",null,null,null,null,null,null,null,null,"重症度、医療・看護必要度の評価票"]
[]
[null,"届出病床数（床）※",null,null,null,null,null,null,"床",null,"届出病床数（床）※",null,null,null,null,null,null,"床"]
[null,"入院患者の状況（令和６年５月～７月）\n※評価票Ⅰの場合のみ記載",null,null,null,null,null,null,null,null,"入院患者の状況（令和６年５月～７月）\n※評価票Ⅰの場合のみ記載"]
[null,"①　入院患者延べ数（名））",null,null,null,null,null,null,"名",null,"①　入院患者延べ数（名））",null,null,null,null,null,null,"名"]
[null,"届出区分①|１、③|１、③|３であって、Ｒ６改定後の評価票にチェックした場合に記載","　②　①のうち以下の重症度、医療・看護必要度\n　　　の基準を満たす患者の延べ数（名）\n　　　A得点３点以上又はC得点１点以上",null,null,null,null,null,"名",null,"②　①のうち重症度、医療・看護必要度の\n　　基準を満たす患者の延べ数（名）",null,null,null,null,null,null,"名"]
[null,null,null,"　③　②の基準を満たす患者の割合（％）\n（②／①×100）\n　　※小数点第１位まで（小数点第２位切り捨て）記入する\n　　※エクセルは自動入力",null,null,null,{"$f":"IF(OR(NOT(ISNUMBER(G13)),NOT(ISNUMBER(H15)),NOT(ISNUMBER(H16)), H15=0, G13=0),\"\",IF(H15=0,0,(ROUNDDOWN(H16/H15*100,1))))","v":""},"％",null,"③　重症度、医療・看護必要度の基準を\n　　満たす患者の割合（％）（②／①×100）\n※小数点第１位まで（小数点第２位切り捨て）記入する\n※エクセルは自動入力",null,null,null,null,null,{"$f":"IF(OR(NOT(ISNUMBER(P13)),NOT(ISNUMBER(Q15)),NOT(ISNUMBER(Q16)), Q15=0, P13=0),\"\",IF(Q15=0,0,(ROUNDDOWN(Q16/Q15*100,1))))","v":""},"％"]
[null,null,"　④　①のうち以下の重症度、医療・看護必要度\n　　の基準を満たす患者の延べ数（名）\n　　A得点２点以上又はC得点１点以上",null,null,null,null,null,"名"]
[null,null,null,"　⑤　④の基準を満たす患者の割合（％）（④／①×100）\n　　※小数点第１位まで（小数点第２位切り捨て）記入する\n　　※エクセルは自動入力",null,null,null,{"$f":"IF(OR(NOT(ISNUMBER(G13)),NOT(ISNUMBER(H15)),NOT(ISNUMBER(H18)), H15=0, G13=0),\"\",IF(H15=0,0,(ROUNDDOWN(H18/H15*100,1))))","v":""},"％",null,"※特定入院料に係る病床数は含めないこと。（特殊疾患入院医療管理料、小児入院医療管理料３（患者数概ね３０名以下で一般病棟等に含まれている場合）・４・５、回復期リハビリテーション入院医療管理料、地域包括ケア入院医療管理料１～４の病室に係る患者についても病床数を含めないこと。）"]
[null,"その他の区分","　⑥　①のうち重症度、医療・看護必要度の\n　　基準を満たす患者の延べ数（名）",null,null,null,null,null,"名"]
[null,null,null,"　⑦　重症度、医療・看護必要度の基準を満たす患者の割合（％）\n（②／①×100）\n　　※小数点第１位まで（小数点第２位切り捨て）記入する\n　　※エクセルは自動入力",null,null,null,{"$f":"IF(OR(NOT(ISNUMBER(G13)),NOT(ISNUMBER(H15)),NOT(ISNUMBER(H20)), H15=0, G13=0),\"\",IF(H15=0,0,(ROUNDDOWN(H20/H15*100,1))))","v":""},"％"]
[]
[null,"【届出区分２】"]
[null,"一般病棟",null,null,null,null,null,null,null,null,"結核病棟\n※一般病棟と結核病棟を併せて１看護単位とする場合を除く。"]
[null,"令和６年８月１日現在の届出区分",null,null,null,null,"",null,null,null,"令和６年８月１日現在の届出区分",null,null,null,null,""]
[null,"看護必要度加算・\n一般病棟看護必要度評価加算",null,null,null,null,"",null,null,null,"看護必要度加算・\n一般病棟看護必要度評価加算"]
[null,"重症度、医療・看護必要度の評価票",null,null,null,null,null,null,null,null,"重症度、医療・看護必要度の評価票"]
[]
[null,"届出病床数（床）※",null,null,null,null,null,null,"床",null,"届出病床数（床）※",null,null,null,null,null,null,"床"]
[null,"入院患者の状況（令和６年５月～７月）\n※評価票Ⅰの場合のみ記載",null,null,null,null,null,null,null,null,"入院患者の状況（令和６年５月～７月）\n※評価票Ⅰの場合のみ記載"]
[null,"①　入院患者延べ数（名））",null,null,null,null,null,null,"名",null,"①　入院患者延べ数（名））",null,null,null,null,null,null,"名"]
[null,"届出区分①|１、③|１、③|３であって、Ｒ６改定後の評価票にチェックした場合に記載","　②　①のうち以下の重症度、医療・看護必要度\n　　　の基準を満たす患者の延べ数（名）\n　　　A得点３点以上又はC得点１点以上",null,null,null,null,null,"名",null,"②　①のうち重症度、医療・看護必要度の\n　　基準を満たす患者の延べ数（名）",null,null,null,null,null,null,"名"]
[null,null,null,"　③　②の基準を満たす患者の割合（％）\n（②／①×100）\n　　※小数点第１位まで（小数点第２位切り捨て）記入する\n　　※エクセルは自動入力",null,null,null,{"$f":"IF(OR(NOT(ISNUMBER(G29)),NOT(ISNUMBER(H31)),NOT(ISNUMBER(H32)), H31=0, G29=0),\"\",IF(H31=0,0,(ROUNDDOWN(H32/H31*100,1))))","v":""},"％",null,"③　重症度、医療・看護必要度の基準を\n　　満たす患者の割合（％）（②／①×100）\n※小数点第１位まで（小数点第２位切り捨て）記入する\n※エクセルは自動入力",null,null,null,null,null,{"$f":"IF(OR(NOT(ISNUMBER(P29)),NOT(ISNUMBER(Q31)),NOT(ISNUMBER(Q32)), Q31=0, P29=0),\"\",IF(Q31=0,0,(ROUNDDOWN(Q32/Q31*100,1))))","v":""},"％"]
[null,null,"　④　①のうち以下の重症度、医療・看護必要度\n　　の基準を満たす患者の延べ数（名）\n　　A得点２点以上又はC得点１点以上",null,null,null,null,null,"名"]
[null,null,null,"　⑤　④の基準を満たす患者の割合（％）（④／①×100）\n　　※小数点第１位まで（小数点第２位切り捨て）記入する\n　　※エクセルは自動入力",null,null,null,{"$f":"IF(OR(NOT(ISNUMBER(G29)),NOT(ISNUMBER(H31)),NOT(ISNUMBER(H34)), H31=0, G29=0),\"\",IF(H31=0,0,(ROUNDDOWN(H34/H31*100,1))))","v":""},"％",null,"※特定入院料に係る病床数は含めないこと。（特殊疾患入院医療管理料、小児入院医療管理料３（患者数概ね３０名以下で一般病棟等に含まれている場合）・４・５、回復期リハビリテーション入院医療管理料、地域包括ケア入院医療管理料１～４の病室に係る患者についても病床数を含めないこと。）"]
[null,"その他の区分","　⑥　①のうち重症度、医療・看護必要度の\n　　基準を満たす患者の延べ数（名）",null,null,null,null,null,"名"]
[null,null,null,"　⑦　重症度、医療・看護必要度の基準を満たす患者の割合（％）\n（②／①×100）\n　　※小数点第１位まで（小数点第２位切り捨て）記入する\n　　※エクセルは自動入力",null,null,null,{"$f":"IF(OR(NOT(ISNUMBER(G29)),NOT(ISNUMBER(H31)),NOT(ISNUMBER(H36)), H31=0, G29=0),\"\",IF(H31=0,0,(ROUNDDOWN(H36/H31*100,1))))","v":""},"％"]
[]
[null,"【届出区分３】"]
[null,"一般病棟",null,null,null,null,null,null,null,null,"結核病棟\n※一般病棟と結核病棟を併せて１看護単位とする場合を除く。"]
[null,"令和６年８月１日現在の届出区分",null,null,null,null,"",null,null,null,"令和６年８月１日現在の届出区分",null,null,null,null,""]
[null,"看護必要度加算・\n一般病棟看護必要度評価加算",null,null,null,null,"",null,null,null,"看護必要度加算・\n一般病棟看護必要度評価加算"]
[null,"重症度、医療・看護必要度の評価票",null,null,null,null,null,null,null,null,"重症度、医療・看護必要度の評価票"]
[]
[null,"届出病床数（床）※",null,null,null,null,null,null,"床",null,"届出病床数（床）※",null,null,null,null,null,null,"床"]
[null,"入院患者の状況（令和６年５月～７月）\n※評価票Ⅰの場合のみ記載",null,null,null,null,null,null,null,null,"入院患者の状況（令和６年５月～７月）\n※評価票Ⅰの場合のみ記載"]
[null,"①　入院患者延べ数（名））",null,null,null,null,null,null,"名",null,"①　入院患者延べ数（名））",null,null,null,null,null,null,"名"]
[null,"届出区分①|１、③|１、③|３であって、Ｒ６改定後の評価票にチェックした場合に記載","　②　①のうち以下の重症度、医療・看護必要度\n　　　の基準を満たす患者の延べ数（名）\n　　　A得点３点以上又はC得点１点以上",null,null,null,null,null,"名",null,"②　①のうち重症度、医療・看護必要度の\n　　基準を満たす患者の延べ数（名）",null,null,null,null,null,null,"名"]
[null,null,null,"　③　②の基準を満たす患者の割合（％）\n（②／①×100）\n　　※小数点第１位まで（小数点第２位切り捨て）記入する\n　　※エクセルは自動入力",null,null,null,{"$f":"IF(OR(NOT(ISNUMBER(G45)),NOT(ISNUMBER(H47)),NOT(ISNUMBER(H48)), H47=0, G45=0),\"\",IF(H47=0,0,(ROUNDDOWN(H48/H47*100,1))))","v":""},"％",null,"③　重症度、医療・看護必要度の基準を\n　　満たす患者の割合（％）（②／①×100）\n※小数点第１位まで（小数点第２位切り捨て）記入する\n※エクセルは自動入力",null,null,null,null,null,{"$f":"IF(OR(NOT(ISNUMBER(P45)),NOT(ISNUMBER(Q47)),NOT(ISNUMBER(Q48)), Q47=0, P45=0),\"\",IF(Q47=0,0,(ROUNDDOWN(Q48/Q47*100,1))))","v":""},"％"]
[null,null,"　④　①のうち以下の重症度、医療・看護必要度\n　　の基準を満たす患者の延べ数（名）\n　　A得点２点以上又はC得点１点以上",null,null,null,null,null,"名"]
[null,null,null,"　⑤　④の基準を満たす患者の割合（％）（④／①×100）\n　　※小数点第１位まで（小数点第２位切り捨て）記入する\n　　※エクセルは自動入力",null,null,null,{"$f":"IF(OR(NOT(ISNUMBER(G45)),NOT(ISNUMBER(H47)),NOT(ISNUMBER(H50)), H47=0, G45=0),\"\",IF(H47=0,0,(ROUNDDOWN(H50/H47*100,1))))","v":""},"％",null,"※特定入院料に係る病床数は含めないこと。（特殊疾患入院医療管理料、小児入院医療管理料３（患者数概ね３０名以下で一般病棟等に含まれている場合）・４・５、回復期リハビリテーション入院医療管理料、地域包括ケア入院医療管理料１～４の病室に係る患者についても病床数を含めないこと。）"]
[null,"その他の区分","　⑥　①のうち重症度、医療・看護必要度の\n　　基準を満たす患者の延べ数（名）",null,null,null,null,null,"名"]
[null,null,null,"　⑦　重症度、医療・看護必要度の基準を満たす患者の割合（％）\n（②／①×100）\n　　※小数点第１位まで（小数点第２位切り捨て）記入する\n　　※エクセルは自動入力",null,null,null,{"$f":"IF(OR(NOT(ISNUMBER(G45)),NOT(ISNUMBER(H47)),NOT(ISNUMBER(H52)), H47=0, G45=0),\"\",IF(H47=0,0,(ROUNDDOWN(H52/H47*100,1))))","v":""},"％"]

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[null,"入院基本料等に関する実施状況報告書（令和６年８月１日現在）　　　　　"]
[null,null,null,null,null,null,null,null,null,null,null,"受付番号※",null,null,null,"※地方厚生（支）局記載　　"]
["（別紙様式１－３）　　【病院記入用】",null,null,null,null,null,null,null,null,"都道府県番号",null,"医療機関コード７桁"]
["※本様式の書式は変えないこと。",null,null,null,null,null,"保険医療機関番号",null,null,{"$f":"IF(data!B1=\"\", \"\", LEFT(data!B1,1))","v":""},{"$f":"IF(data!B1=\"\", \"\", RIGHT(data!B1, 1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,1,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,2,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,3,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,4,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,5,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,6,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,7,1))","v":""}]
[null,"褥瘡対策に係る報告書"]
[]
[null,"※１名の患者が複数褥瘡を有していても、患者１名として数える。",null,null,null,null,null,null,"※エクセル上で入力した場合は、「自動チェック」が「○」となっていることを確認すること。"]
[null,"※該当患者がいない場合、「０」と書くこと。",null,null,null,null,null,null,"　手書きの場合は、各合計が一致していることを注意書きを参考に確認すること。"]
[]
[null,"【届出区分１】"]
[null,"褥瘡対策の実施状況（令和６年７月１日における実績・状況）",null,null,null,null,null,null,null,null,null,"１．一般病棟入院基本料等",null,"２．療養病棟入院基本料",null,"３．　１及び２以外を算定する病棟等"]
[null,null,null,null,null,null,null,null,null,null,null,"令和６年８月１日現在の届出区分",null,"令和６年８月１日現在の届出区分",null,"※特殊疾患入院医療管理料、小児入院医療管理料３・４・５、回復期リハビリテーション入院医療管理料、地域包括ケア入院医療管理料１～４の病室に係る患者を含む"]
[null,"①","　入院患者数（令和６年７月１日の入院患者数）",null,null,null,null,null,null,null,null,null,"名",null,"名",null,"名"]
[null,"②","　①のうち、d1以上の褥瘡を有していた患者数（褥瘡保有者数）",null,null,null,null,null,null,null,null,null,"名",null,"名",null,"名"]
[null,"③","　②のうち、入院時に既に褥瘡を有していた患者数（入院時褥瘡保有者数）",null,null,null,null,null,null,null,null,null,"名",null,"名",null,"名",null,null,{"$f":"IF(L15=\"\",1,0)","v":1},{"$f":"IF(N15=\"\",1,0)","v":1},{"$f":"IF(P15=\"\",1,0)","v":1}]
[null,"④","　②のうち、入院中に新たに褥瘡が発生した患者数（※②－③の患者数）",null,null,null,null,null,null,null,null,null,"名",null,"名",null,"名",null,null,{"$f":"IF(L16=\"\",1,0)","v":1},{"$f":"IF(N16=\"\",1,0)","v":1},{"$f":"IF(P16=\"\",1,0)","v":1}]
[null,null,null,null,null,null,null,null,null,null,"①～④が入力されていること、④が②－③と一致していることを確認→","自動チェック：",{"$f":"IF(M12=\"\",\"\",IF(L13=\"\",\"×\",IF(L14=\"\",\"×\",IF(L15=\"\",\"×\",IF(L16=\"\",\"×\",IF(L14-L15=L16,\"○\",\"✕\"))))))","v":""},"自動チェック：",{"$f":"IF(O12=\"\",\"\",IF(N13=\"\",\"×\",IF(N14=\"\",\"×\",IF(N15=\"\",\"×\",IF(N16=\"\",\"×\",IF(N14-N15=N16,\"○\",\"✕\"))))))","v":""},"自動チェック：",{"$f":"IF(P13=\"\",\"\",IF(P13<P14,\"×\",IF(P14=\"\",\"×\",IF(P15=\"\",\"×\",IF(P16=\"\",\"×\",IF(P14-P15=P16,\"○\",\"✕\"))))))","v":""}]
[]
[null,null,"　体圧分散マットレス等に関する体制の整備状況",null,null,null,null,null,null,null,false,"体圧分散マットレスを保有している",null,null,null,null,"）台"]
[null,"⑤",null,null,null,null,null,null,null,null,false,"エアマットレスを保有している ",null,null,null,null,"）台"]
[null,null,"※　　を付すこと（複数選択可）。\n・体圧分散マットレス又はエアマットレスを保有している場合は、台数を記載すること。\n・体圧分散マットレス等をレンタルしている場合は、「保有している」の欄には記載せず、「その他」にチェックし自由記載にその旨を記載すること。\n・自由記載は簡潔に文章で記載すること。",null,null,null,null,null,null,null,false,"体圧分散用枕を保有している"]
[null,null,null,null,null,null,null,null,null,null,false,"車いす用のクッションを保有している"]
[null,null,null,null,null,null,null,null,null,null,false,"その他（自由記載)"]
[]
[]
[null,"⑥","　褥瘡の重症度",null,null,null,null,null,null,null,null,"入院時の褥瘡（③の患者の入院時の状況）",null,null,"院内発生した褥瘡（④の患者の発見時の状況）"]
[null,null,null,null,null,null,null,null,null,null,"ｄ1",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"ｄ2",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"D3",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"D4",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"D5",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"DDTI",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"DU",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,null,"↑③の合計と一致していることを確認",null,null,"↑④の合計と一致していることを確認"]
[null,null,null,null,null,null,null,null,null,null,null,"自動チェック：",{"$f":"IF(SUM(T15:V15)=3,\"\",IF(L15+N15+P15=SUM(L27:M33),\"○\",\"✕\"))","v":""},null,"自動チェック：",{"$f":"IF(SUM(T16:V16)=3,\"\",IF(L16+N16+P16=SUM(O27:P33),\"○\",\"✕\"))","v":""}]
[]
[null,"【届出区分２】"]
[null,"褥瘡対策の実施状況（令和６年７月１日における実績・状況）",null,null,null,null,null,null,null,null,null,"１．一般病棟入院基本料等",null,"２．療養病棟入院基本料",null,"３．　１及び２以外を算定する病棟等"]
[null,null,null,null,null,null,null,null,null,null,null,"令和６年８月１日現在の届出区分",null,"令和６年８月１日現在の届出区分",null,"※特殊疾患入院医療管理料、小児入院医療管理料３・４・５、回復期リハビリテーション入院医療管理料、地域包括ケア入院医療管理料１～４の病室に係る患者を含む"]
[null,"①","　入院患者数（令和６年７月１日の入院患者数）",null,null,null,null,null,null,null,null,null,"名",null,"名",null,"名"]
[null,"②","　①のうち、d1以上の褥瘡を有していた患者数（褥瘡保有者数）",null,null,null,null,null,null,null,null,null,"名",null,"名",null,"名"]
[null,"③","　②のうち、入院時に既に褥瘡を有していた患者数（入院時褥瘡保有者数）",null,null,null,null,null,null,null,null,null,"名",null,"名",null,"名",null,null,{"$f":"IF(L42=\"\",1,0)","v":1},{"$f":"IF(N42=\"\",1,0)","v":1},{"$f":"IF(P42=\"\",1,0)","v":1}]
[null,"④","　②のうち、入院中に新たに褥瘡が発生した患者数（※②－③の患者数）",null,null,null,null,null,null,null,null,null,"名",null,"名",null,"名",null,null,{"$f":"IF(L43=\"\",1,0)","v":1},{"$f":"IF(N43=\"\",1,0)","v":1},{"$f":"IF(P43=\"\",1,0)","v":1}]
[null,null,null,null,null,null,null,null,null,null,"①～④が入力されていること、④が②－③と一致していることを確認→","自動チェック：",{"$f":"IF(M39=\"\",\"\",IF(L40=\"\",\"×\",IF(L41=\"\",\"×\",IF(L42=\"\",\"×\",IF(L43=\"\",\"×\",IF(L41-L42=L43,\"○\",\"✕\"))))))","v":""},"自動チェック：",{"$f":"IF(O39=\"\",\"\",IF(N40=\"\",\"×\",IF(N41=\"\",\"×\",IF(N42=\"\",\"×\",IF(N43=\"\",\"×\",IF(N41-N42=N43,\"○\",\"✕\"))))))","v":""},"自動チェック：",{"$f":"IF(P40=\"\",\"\",IF(P40<P41,\"×\",IF(P41=\"\",\"×\",IF(P42=\"\",\"×\",IF(P43=\"\",\"×\",IF(P41-P42=P43,\"○\",\"✕\"))))))","v":""}]
[]
[null,null,"　体圧分散マットレス等に関する体制の整備状況",null,null,null,null,null,null,null,false,"体圧分散マットレスを保有している",null,null,null,null,"）台"]
[null,"⑤",null,null,null,null,null,null,null,null,false,"エアマットレスを保有している",null,null,null,null,"）台"]
[null,null,"※　　を付すこと（複数選択可）。\n・体圧分散マットレス又はエアマットレスを保有している場合は、台数を記載すること。\n・体圧分散マットレス等をレンタルしている場合は、「保有している」の欄には記載せず、「その他」にチェックし自由記載にその旨を記載すること。\n・自由記載は簡潔に文章で記載すること。",null,null,null,null,null,null,null,false,"体圧分散用枕を保有している"]
[null,null,null,null,null,null,null,null,null,null,false,"車いす用のクッションを保有している"]
[null,null,null,null,null,null,null,null,null,null,false,"その他（自由記載)"]
[]
[]
[null,"⑥","　褥瘡の重症度",null,null,null,null,null,null,null,null,"入院時の褥瘡（③の患者の入院時の状況）",null,null,"院内発生した褥瘡（④の患者の発見時の状況）"]
[null,null,null,null,null,null,null,null,null,null,"ｄ1",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"ｄ2",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"D3",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"D4",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"D5",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"DDTI",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"DU",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,null,"↑③の合計と一致していることを確認",null,null,"↑④の合計と一致していることを確認"]
[null,null,null,null,null,null,null,null,null,null,null,"自動チェック：",{"$f":"IF(SUM(T42:V42)=3,\"\",IF(L42+N42+P42=SUM(L54:M60),\"○\",\"✕\"))","v":""},null,"自動チェック：",{"$f":"IF(SUM(T43:V43)=3,\"\",IF(L43+N43+P43=SUM(O54:P60),\"○\",\"✕\"))","v":""}]
[]
[null,"【届出区分３】"]
[null,"褥瘡対策の実施状況（令和６年７月１日における実績・状況）",null,null,null,null,null,null,null,null,null,"１．一般病棟入院基本料等",null,"２．療養病棟入院基本料",null,"３．　１及び２以外を算定する病棟等"]
[null,null,null,null,null,null,null,null,null,null,null,"令和６年８月１日現在の届出区分",null,"令和６年８月１日現在の届出区分",null,"※特殊疾患入院医療管理料、小児入院医療管理料３・４・５、回復期リハビリテーション入院医療管理料、地域包括ケア入院医療管理料１～４の病室に係る患者を含む"]
[null,"①","　入院患者数（令和６年７月１日の入院患者数）",null,null,null,null,null,null,null,null,null,"名",null,"名",null,"名"]
[null,"②","　①のうち、d1以上の褥瘡を有していた患者数（褥瘡保有者数）",null,null,null,null,null,null,null,null,null,"名",null,"名",null,"名"]
[null,"③","　②のうち、入院時に既に褥瘡を有していた患者数（入院時褥瘡保有者数）",null,null,null,null,null,null,null,null,null,"名",null,"名",null,"名",null,null,{"$f":"IF(L69=\"\",1,0)","v":1},{"$f":"IF(N69=\"\",1,0)","v":1},{"$f":"IF(P69=\"\",1,0)","v":1}]
[null,"④","　②のうち、入院中に新たに褥瘡が発生した患者数（※②－③の患者数）",null,null,null,null,null,null,null,null,null,"名",null,"名",null,"名",null,null,{"$f":"IF(L70=\"\",1,0)","v":1},{"$f":"IF(N70=\"\",1,0)","v":1},{"$f":"IF(P70=\"\",1,0)","v":1}]
[null,null,null,null,null,null,null,null,null,null,"①～④が入力されていること、④が②－③と一致していることを確認→","自動チェック：",{"$f":"IF(M66=\"\",\"\",IF(L67=\"\",\"×\",IF(L68=\"\",\"×\",IF(L69=\"\",\"×\",IF(L70=\"\",\"×\",IF(L68-L69=L70,\"○\",\"✕\"))))))","v":""},"自動チェック：",{"$f":"IF(O66=\"\",\"\",IF(N67=\"\",\"×\",IF(N68=\"\",\"×\",IF(N69=\"\",\"×\",IF(N70=\"\",\"×\",IF(N68-N69=N70,\"○\",\"✕\"))))))","v":""},"自動チェック：",{"$f":"IF(P67=\"\",\"\",IF(P67<P68,\"×\",IF(P68=\"\",\"×\",IF(P69=\"\",\"×\",IF(P70=\"\",\"×\",IF(P68-P69=P70,\"○\",\"✕\"))))))","v":""}]
[]
[null,null,"　体圧分散マットレス等に関する体制の整備状況",null,null,null,null,null,null,null,false,"体圧分散マットレスを保有している",null,null,null,null,"）台"]
[null,"⑤",null,null,null,null,null,null,null,null,false,"エアマットレスを保有している",null,null,null,null,"）台"]
[null,null,"※　　を付すこと（複数選択可）。\n・体圧分散マットレス又はエアマットレスを保有している場合は、台数を記載すること。\n・体圧分散マットレス等をレンタルしている場合は、「保有している」の欄には記載せず、「その他」にチェックし自由記載にその旨を記載すること。\n・自由記載は簡潔に文章で記載すること。",null,null,null,null,null,null,null,false,"体圧分散用枕を保有している"]
[null,null,null,null,null,null,null,null,null,null,false,"車いす用のクッションを保有している"]
[null,null,null,null,null,null,null,null,null,null,false,"その他（自由記載)"]
[]
[]
[null,"⑥","　褥瘡の重症度",null,null,null,null,null,null,null,null,"入院時の褥瘡（③の患者の入院時の状況）",null,null,"院内発生した褥瘡（④の患者の発見時の状況）"]
[null,null,null,null,null,null,null,null,null,null,"ｄ1",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"ｄ2",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"D3",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"D4",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"D5",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"DDTI",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"DU",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,null,"↑③の合計と一致していることを確認",null,null,"↑④の合計と一致していることを確認"]
[null,null,null,null,null,null,null,null,null,null,null,"自動チェック：",{"$f":"IF(SUM(T69:V69)=3,\"\",IF(L69+N69+P69=SUM(L81:M87),\"○\",\"✕\"))","v":""},null,"自動チェック：",{"$f":"IF(SUM(T70:V70)=3,\"\",IF(L70+N70+P70=SUM(O81:P87),\"○\",\"✕\"))","v":""}]
[]
[null,"【届出区分４】"]
[null,"褥瘡対策の実施状況（令和６年７月１日における実績・状況）",null,null,null,null,null,null,null,null,null,"１．一般病棟入院基本料等",null,"２．療養病棟入院基本料",null,"３．　１及び２以外を算定する病棟等"]
[null,null,null,null,null,null,null,null,null,null,null,"令和６年８月１日現在の届出区分",null,"令和６年８月１日現在の届出区分",null,"※特殊疾患入院医療管理料、小児入院医療管理料３・４・５、回復期リハビリテーション入院医療管理料、地域包括ケア入院医療管理料１～４の病室に係る患者を含む"]
[null,"①","　入院患者数（令和６年７月１日の入院患者数）",null,null,null,null,null,null,null,null,null,"名",null,"名",null,"名"]
[null,"②","　①のうち、d1以上の褥瘡を有していた患者数（褥瘡保有者数）",null,null,null,null,null,null,null,null,null,"名",null,"名",null,"名"]
[null,"③","　②のうち、入院時に既に褥瘡を有していた患者数（入院時褥瘡保有者数）",null,null,null,null,null,null,null,null,null,"名",null,"名",null,"名",null,null,{"$f":"IF(L96=\"\",1,0)","v":1},{"$f":"IF(N96=\"\",1,0)","v":1},{"$f":"IF(P96=\"\",1,0)","v":1}]
[null,"④","　②のうち、入院中に新たに褥瘡が発生した患者数（※②－③の患者数）",null,null,null,null,null,null,null,null,null,"名",null,"名",null,"名",null,null,{"$f":"IF(L97=\"\",1,0)","v":1},{"$f":"IF(N97=\"\",1,0)","v":1},{"$f":"IF(P97=\"\",1,0)","v":1}]
[null,null,null,null,null,null,null,null,null,null,"①～④が入力されていること、④が②－③と一致していることを確認→","自動チェック：",{"$f":"IF(M93=\"\",\"\",IF(L94=\"\",\"×\",IF(L95=\"\",\"×\",IF(L96=\"\",\"×\",IF(L97=\"\",\"×\",IF(L95-L96=L97,\"○\",\"✕\"))))))","v":""},"自動チェック：",{"$f":"IF(O93=\"\",\"\",IF(N94=\"\",\"×\",IF(N95=\"\",\"×\",IF(N96=\"\",\"×\",IF(N97=\"\",\"×\",IF(N95-N96=N97,\"○\",\"✕\"))))))","v":""},"自動チェック：",{"$f":"IF(P94=\"\",\"\",IF(P94<P95,\"×\",IF(P95=\"\",\"×\",IF(P96=\"\",\"×\",IF(P97=\"\",\"×\",IF(P95-P96=P97,\"○\",\"✕\"))))))","v":""}]
[]
[null,null,"　体圧分散マットレス等に関する体制の整備状況",null,null,null,null,null,null,null,false,"体圧分散マットレスを保有している",null,null,null,null,"）台"]
[null,"⑤",null,null,null,null,null,null,null,null,false,"エアマットレスを保有している",null,null,null,null,"）台"]
[null,null,"※　　を付すこと（複数選択可）。\n・体圧分散マットレス又はエアマットレスを保有している場合は、台数を記載すること。\n・体圧分散マットレス等をレンタルしている場合は、「保有している」の欄には記載せず、「その他」にチェックし自由記載にその旨を記載すること。\n・自由記載は簡潔に文章で記載すること。",null,null,null,null,null,null,null,false,"体圧分散用枕を保有している"]
[null,null,null,null,null,null,null,null,null,null,false,"車いす用のクッションを保有している"]
[null,null,null,null,null,null,null,null,null,null,false,"その他（自由記載)"]
[]
[]
[null,"⑥","　褥瘡の重症度",null,null,null,null,null,null,null,null,"入院時の褥瘡（③の患者の入院時の状況）",null,null,"院内発生した褥瘡（④の患者の発見時の状況）"]
[null,null,null,null,null,null,null,null,null,null,"ｄ1",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"ｄ2",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"D3",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"D4",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"D5",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"DDTI",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,"DU",null,null,"名",null,null,"名"]
[null,null,null,null,null,null,null,null,null,null,null,"↑③の合計と一致していることを確認",null,null,"↑④の合計と一致していることを確認"]
[null,null,null,null,null,null,null,null,null,null,null,"自動チェック：",{"$f":"IF(SUM(T96:V96)=3,\"\",IF(L96+N96+P96=SUM(L108:M114),\"○\",\"✕\"))","v":""},null,"自動チェック：",{"$f":"IF(SUM(T97:V97)=3,\"\",IF(L97+N97+P97=SUM(O108:P114),\"○\",\"✕\"))","v":""}]

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[null,"有床診療所入院基本料等に関する実施状況報告書（令和６年８月１日現在）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"受付番号※",null,null,null,"※地方厚生（支）局記載　　"]
["（別紙様式２）　　【有床診療所記入用】",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"都道府県番号",null,"医療機関コード７桁"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保険医療機関番号",null,null,null,{"$f":"IF(data!B1=\"\", \"\", LEFT(data!B1,1))","v":""},{"$f":"IF(data!B1=\"\", \"\", RIGHT(data!B1, 1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,1,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,2,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,3,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,4,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,5,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,6,1))","v":""},{"$f":"IF(data!C1=\"\",\"\",MID(data!C1,7,1))","v":""}]
["医療機関名",null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""},null,null,null,null,null,null,null,null,"開設者\n番号",null,null,null,{"$f":"IF(data!R1111=0,\"\",INDEX(list!E2:E27,data!R1111))","v":""},null,null,"都道府県名",null,null,{"$f":"IF(data!B1=\"\",\"\",VLOOKUP(data!B1,list!A3:C49,3,FALSE))","v":""},null,null,null,"郡市区町村名"]
["届出区分",null,null,"許可病床数","医療保険届出病床数","稼働病床数","１日平均\n入院患者数","現員数",null,null,null,"施設基準\n（該当する記号全てに　　を付すこと）\n※該当する場合は実績件数も記載すること。",null,null,null,null,null,null,null,null,null,"実績\n件数","診療科名",null,null,null,"加算の届出の有無\n（届出加算に　　を付すこと）\n※届出を行っていない場合は☑の記入は不要"]
[null,null,null,null,null,null,null,"医師","看護師","准看護師","看護補助者"]
[]
["有床診療所　　\n 入院基本料１",null,null,null,null,null,null,null,null,null,null,false,"イ","以下の１～３のいずれかに該当すること（該当する記号全てに　　 を付すこと）",null,null,null,null,null,null,null,null,false,"1.内科　",null,null,false,"有床診療所急性期患者支援病床初期加算"]
[null,null,null,null,null,null,null,null,null,null,null,null,false,"　１　過去１年間に、介護保険の通所リハビリテーション、",null,null,null,null,null,null,null,null,false,"2.心療内科",null,null,false,"有床診療所在宅患者支援病床初期加算"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"　　介護予防通所リハビリテーション、",null,null,null,null,null,null,null,null,false,"3.精神科",null,null,false,"有床診療所急性期患者支援療養病床初期加算"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"　　居宅療養管理指導、介護予防居宅療養管理指導、",null,null,null,null,null,null,null,null,false,"4.神経科(又は神経内科)",null,null,false,"有床診療所在宅患者支援療養病床初期加算"]
["有床診療所　\n 入院基本料２",null,null,null,null,null,null,null,null,null,null,null,null,"　　短期入所療養介護、介護予防短期入所療養介護又は",null,null,null,null,null,null,null,null,false,"5.呼吸器科",null,null,false,"夜間緊急体制確保加算"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"　　複合型サービスの提供実績がある。",null,null,null,null,null,null,null,null,false,"6.消化器科(又は胃腸科)",null,null,false,"医師配置加算１"]
[null,null,null,null,null,null,null,null,null,null,null,null,false,"　２　介護医療院を併設している。",null,null,null,null,null,null,null,null,false,"7.循環器科　　 ",null,null,false,"医師配置加算２"]
[null,null,null,null,null,null,null,null,null,null,null,null,false,"　３　指定居宅介護支援事業者又は指定介護予防サービス",null,null,null,null,null,null,null,null,false,"8.アレルギー科",null,null,false,"看護配置加算１"]
["有床診療所\n 入院基本料３",null,null,null,null,null,null,null,null,null,null,null,null,"　　事業者である。",null,null,null,null,null,null,null,null,false,"9.リウマチ科　",null,null,false,"看護配置加算２"]
[null,null,null,null,null,null,null,null,null,null,null,false,"ロ","在宅療養支援診療所であって、過去1年間に訪問診療を実施した",null,null,null,null,null,null,null,"訪問件数",false,"10.小児科　",null,null,false,"夜間看護配置加算１"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"実績がある。",null,null,null,null,null,null,null,null,false,"11.外科",null,null,false,"夜間看護配置加算２"]
[null,null,null,null,null,null,null,null,null,null,null,false,"ハ","過去１年間の急変時の入院件数が６件以上である。",null,null,null,null,null,null,null,"入院件数",false,"12.整形外科　 ",null,null,false,"看護補助配置加算１"]
["有床診療所　　\n 入院基本料４",null,null,null,null,null,null,null,null,null,null,null,null,"（予定入院は除く。）",null,null,null,null,null,null,null,null,false,"13.形成外科",null,null,false,"看護補助配置加算２"]
[null,null,null,null,null,null,null,null,null,null,null,false,"ニ","夜間看護配置加算１又は２の届出を行っている。",null,null,null,null,null,null,null,null,false,"14.美容外科　 ",null,null,false,"看取り加算"]
[null,null,null,null,null,null,null,null,null,null,null,false,"ホ","時間外対応加算１の届出を行っている。",null,null,null,null,null,null,null,null,false,"15.脳神経外科",null,null,false,"栄養管理実施加算"]
[null,null,null,null,null,null,null,null,null,null,null,false,"ヘ","過去1年間の新規入院患者のうち、他の急性期医療を担う病院の",null,null,null,null,null,null,null,"受入割合",false,"16.呼吸器外科　",null,null,false,"有床診療所在宅復帰機能強化加算"]
["有床診療所　\n 入院基本料５",null,null,null,null,null,null,null,null,null,null,null,null,"一般病棟からの受入れが1割以上である。",null,null,null,null,null,null,null,null,false,"17.心臓血管外科",null,null,false,"有床診療所療養病床在宅復帰機能強化加算"]
[null,null,null,null,null,null,null,null,null,null,null,false,"ト","過去1年間の当該保険医療機関内における看取りの実績が2件以上",null,null,null,null,null,null,null,"看取件数",false,"18.小児外科",null,null,false,"医師事務作業補助体制加算１（50対１）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"である。",null,null,null,null,null,null,null,null,false,"19.皮膚泌尿器科\n　(又は皮膚科、泌尿器科)",null,null,false,"医師事務作業補助体制加算１（75対１）"]
[null,null,null,null,null,null,null,null,null,null,null,false,"チ","過去1年間の全身麻酔、脊椎麻酔又は硬膜外麻酔（手術を実施した",null,null,null,null,null,null,null,"当該患者数",null,null,null,null,false,"医師事務作業補助体制加算１（100対１）"]
["有床診療所\n 入院基本料６",null,null,null,null,null,null,null,null,null,null,null,null,"場合に限る。）の患者数（分娩を除く。）が30件以上である。",null,null,null,null,null,null,null,null,false,"20.性病科　　 ",null,null,false,"医師事務作業補助体制加算２（50対１）"]
[null,null,null,null,null,null,null,null,null,null,null,false,"リ","医療資源の少ない地域※に所在する有床診療所である。",null,null,null,null,null,null,null,null,false,"21.こう門科",null,null,false,"医師事務作業補助体制加算２（75対１）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"※特定一般病棟入院料の「注１」に規定する地域",null,null,null,null,null,null,null,null,false,"22.産婦人科(又は産科、婦人科)",null,null,false,"医師事務作業補助体制加算２（100対１）"]
[null,null,null,null,null,null,null,null,null,null,null,false,"ヌ","過去1年間の分娩を行った総数（帝王切開を含む。）が30件以上",null,null,null,null,null,null,null,"分娩件数",false,"23.眼科　　　 ",null,null,false,"有床診療所緩和ケア診療加算"]
["療養病床",null,null,null,null,null,null,null,null,null,null,null,null,"である。",null,null,null,null,null,null,null,null,false,"24.耳鼻いんこう科"]
[null,null,null,null,null,null,null,null,null,null,null,false,"ル","過去1年間に、乳幼児加算・幼児加算、超重症児(者)入院診療加算・",null,null,null,null,null,null,null,null,false,"25.気管食道科　"]
[null,"※いずれかを選択する",null,null,null,null,null,null,null,null,null,null,null,"準超重症児(者)入院診療加算又は小児療養環境特別加算を算定",null,null,null,null,null,null,null,null,false,"26.リハビリテーション科"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"した実績がある。",null,null,null,null,null,null,null,null,false,"27.放射線科　 "]
[null,null,null,null,null,null,null,null,null,null,null,"　有床診療所入院基本料１～３の届出施設",null,null,null,null,null,null,null,false,null,null,false,"28.麻酔科　"]
[null,"※　「１日平均入院患者数」は１人未満の端数は、切り上げること。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,null,null,false,"29.歯科"]
[null,"※　「現員数」は１人未満の端数は、小数点第二位（小数点第三位切り捨て）までの実数を記載すること。また、１人の医師、看護師、准看護師又は看護補助者について算出した値が1.0を超える場合は、1.00人とすること。",null,null,null,null,null,null,null,null,null,"※",null,"有床診療所入院基本料１～３については、上記要件のうちイに該当、"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"又はロ～ルまでのうち２つ以上に該当すること。"]

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["（別紙様式３）",null,null,null,null,null,null,null,null,"（令和６年８月１日現在）"]
["保険薬局における施設基準届出状況報告書"]
[]
[null,null,null,null,null,null,null,"都道府県名",null,{"$f":"IF(data!B1=\"\",\"\",VLOOKUP(data!B1,list!A3:C49,3,FALSE))","v":""}]
[]
[null,"　 薬局コード",null,null,{"$f":"IF(data!C1=\"\", \"\", data!C1)","v":""},null,"（※レセプトに記載する７桁の数字を記入すること。）"]
[null,"　 保険薬局名",null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[null,"　 指定年月日",null,null,null,null,null,"※全ての保険薬局が和暦で記入。\n※記載の薬局コードを初めて取得した年月日を記入（指定更新後の指定年月日でない）。"]
[]
[null,"　 遡及指定※が認められた保険薬局への該当"]
[null,"保険薬剤師数",null,"・実人員\n（常勤＋非常勤）",null,null,"・常勤換算\n※常勤人数と非常勤の常勤換算した人数の合計（小数点以下第２位四捨五入）"]
[null,"事務職員数",null,"・実人員\n（常勤＋非常勤）",null,null,"・常勤換算\n※常勤人数と非常勤の常勤換算した人数の合計（小数点以下第２位四捨五入）"]
[]
[null,"１．調剤基本料"]
[]
[null,null,"①　処方箋受付回数\n\n前年５月から本年４月末までの処方箋受付回数の合計を記入すること。\n（※前年５月１日から当年３月末までに新規指定された保険薬局の場合は指定された日の属する月の翌月から、当年４月末までに受け付けた処方箋回数の合計を記入すること。）\n",null,null,null,"ア　１年間の処方箋受付回数の合計\n（※前年５月１日から当年３月末までに新規指定された保険薬局の場合は指定された日の属する月の翌月から、当年４月末までに受け付けた処方箋回数の合計を記入）"]
[null,null,null,null,null,null,"イ　前年５月１日から当年３月末までに新規指定された保険薬局の場合は指定された日の属する月の翌月を記入すること。\n（※前年４月末までに指定された場合及び遡及指定が認められた場合は記入不要）",null,"上記受付回数算出期間"]
[]
[]
[null,null,"②　１月あたりの処方箋受付回数",null,null,null,"※計算方法\n①のアの回数を月数で除した値として１月あたりの処方箋受付回数を記入すること\n（※①の記入ができない場合は直近１月あたりの処方箋受付回数を記入すること）"]
[null,null,"③　保険医療機関に係る処方箋集中率\n（小数点以下第２位を切り上げて計算し、小数点第１位まで記入すること）",null,null,null,"処方箋受付回数が第１位の医療機関に係る集中率"]
[null,null,null,null,null,null,"処方箋受付回数が第２位の医療機関に係る集中率"]
[null,null,null,null,null,null,"処方箋受付回数が第３位の医療機関に係る集中率"]
[null,null,"④ 所属するグループの有無"]
[null,null,null,"ア 所属するグループ名（※調剤基本料の区分によらず、所属するグループがある全ての保険薬局が回答）"]
[null,null,"（※④を「あり」と記入した場合に記入）","イ 同一グループ内の保険薬局の数（当該保険薬局を含む）"]
[null,null,null,"ウ グループ内の1月あたりの処方箋受付回数の合計"]
[null,null,null,"エ 同一グループ内の主たる保険医療機関を同じくする他の保険薬局の有無及び自局と該当する他の保険薬局の処方箋受付回数の合計（１月あたり）"]
[null,null,"⑤ 特定の保険医療機関と不動産の賃貸借取引等の有無\n（※調剤基本料の位置づけによらず、全ての保険薬局が実態どおりに回答）"]
[null,null,"（※⑤を「あり」と記入した場合に記入）","・ 賃貸借取引等がある保険医療機関の種別"]
[null,null,null,"・ 賃貸借取引等がある保険医療機関の名称"]
[null,null,null,"・ 賃貸借取引等がある保険医療機関に係る処方箋集中率"]
[null,null,null,"・ 特定の保険医療機関と不動産の賃貸借取引等に新たに該当することになった時期について該当するものにチェック\n（※ア～オの当てはまるもの全てにチェック。なお、平成28年９月30日以前に該当した場合はア～オのチェック不要。）",null,null,"平成28年９月30日以前\n（該当する場合は\nア～オのチェック不要）\n\n","平成28年10月1日から平成30年3月31日の間\n（該当する場合、ア～オの当てはまるもの全てにチェック）\n\n\n",null,"平成30年4月１日以降\n（該当する場合、ア～オの当てはまるもの全てにチェック）\n\n"]
[]
[null,null,null,null,"ア  保険医療機関と直接不動産の賃貸借取引（保険医療機関及び保険薬局の開設者の近親者又は法人の役員が名義人となっている場合を含む）がある"]
[null,null,null,null,"イ  保険医療機関と第三者を通じて不動産の賃貸借取引（賃料が発生しない場合を含む）がある（第三者による転借が複数回行われている場合を含む）"]
[null,null,null,null," ウ 保険医療機関が譲り渡した不動産（保険薬局以外の者に譲り渡した場合を含む）を利用して開局している"]
[null,null,null,null," エ 保険薬局が所有する施設・設備を保険医療機関に貸与している"]
[null,null,null,null," オ 保険医療機関による開局時期の指定を受けて開局している（病院又はその開設者からの依頼により第三者が公募する場合を含む）（公募の際に、開局時期が明示されていない場合を含む）"]
[null,null,"⑥ 調剤基本料の注４の減算への該当性　（※全ての保険薬局が回答）"]
[null,null,"（※ア及びイは前年の報告実績に基づき記入。前年４月２日以降の開局のため、前年の報告実績がない薬局は、ア＝「非該当」、イ＝「報告していない」を選択。）\n（※ウは前年５月１日から本年４月末までの実績に基づき記入。ただし、処方箋の受付回数が１月平均600回以下の場合は、「非該当」を選択。「かかりつけ薬剤師指導料及びかかりつけ薬剤師包括管理料」に関する設問ではないので留意すること。）"]
[null,null,"ア 妥結率が5割以下の保険薬局への該当"]
[null,null,"イ 妥結率等の報告の有無"]
[null,null,"ウ 薬剤師のかかりつけ機能に係る基本的な業務を実施していない保険薬局への該当"]
[]
[null,"薬局コード：",null,{"$f":"E6","v":""}]
[]
[null,"２．調剤基本料の注１ただし書きに規定する施設基準の保険薬局\n　　（医療資源の少ない地域に所在する保険薬局）への該当"]
[null,null,"基本診療料の施設基準等の別表第六の二の所在する保険薬局への該当（※「届出していない」場合も記入が必要）"]
[]
[null,"３．地域支援体制加算（※全ての保険薬局が回答）"]
[]
[null,null,"① 備蓄医療用医薬品数\n（※「届出していない」場合も記入が必要）"]
[null,null,"② 要指導医薬品及び一般用医薬品の合計品目数\n（※「届出していない」場合も記入が必要）"]
[null,"４．連携強化加算"]
[null,"５．後発医薬品調剤体制加算\n　　（※「届出していない」場合も下記の記入が必要）"]
[null,null,"① 本年５月２日以降に新規指定を受けた場合等、直近3か月間の実績がない保険薬局への該当"]
[null,null,"② 新指標の割合（小数点以下切り捨て）",null,null,null,"③ カットオフ値の割合\n（小数点以下切り捨て）"]
[null,null,"④ ②に「後発医薬品の出荷停止等を踏まえた診療報酬上の臨時的な取扱いについて」を適用した保険薬局への該当"]
[null,null,"⑤ 調剤基本料の注８に規定する厚生労働大臣が定める保険薬局への該当（後発医薬品減算）\n（※処方箋受付回数が１月600回以下の場合は、「非該当」を選択）"]
[null,"６．在宅薬学総合体制加算\n　　（※「届出していない」場合も②から④の記入が必要）"]
[null,"① （在宅薬学総合体制加算２の届出薬局のみ）\n適合する施設要件（両方に適合する場合は、両方に☑）",null,null,null,null,false,null,false]
[null,"②医療用麻薬の備蓄品目数\n（届出の有無にかかわらず全ての保険薬局が回答）"]
[null,"③「在宅患者訪問薬剤管理指導料（在宅患者オンライン薬剤管理指導料を除く）」(医療保険)の回数と患者数\n（届出の有無にかかわらず全ての保険薬局が回答）",null,null,null,null,"　　ア. 算定回数　","(前年５月から本年４月までの合計回数)"]
[null,null,null,null,null,null,"　　イ. 実施患者数","(前年５月から本年４月までの合計人数)"]
[null,"④「居宅療養管理指導費」及び「介護予防居宅療養管理指導費」(介護保険)（情報通信機器を用いた場合は除く）の回数と利用者数\n（届出の有無にかかわらず全ての保険薬局が回答）",null,null,null,null,"　　ア. 算定回数　","(前年５月から本年４月までの合計回数)"]
[null,null,null,null,null,null,"　　イ. 利用者数","(前年５月から本年４月までの合計人数)"]
[null,"７．医療DX推進体制整備加算\n　　（※「届出していない」場合も下記の記入が必要）"]
[null,null,"①電子処方箋により調剤する体制の整備\n（届出の有無にかかわらず全ての保険薬局が回答）"]
[null,"８．無菌製剤処理加算"]
[null,null,"①無菌製剤処理を実施する場所"]
[null,null,"②自局にて無菌製剤処理を行うための設備",null,null,null,false,false,false]
[null,"９．服薬管理指導料"]
[null,null,"① 特定薬剤管理指導加算２"]
[null,null,"② 本年５月２日以降に新規指定を受けた場合等、直近3か月間の実績がない保険薬局への該当"]
[null,null,"③ 注13で規定する厚生労働大臣が定める保険薬局（手帳の活用実績が少ない保険薬局）への該当"]
[null,null,"④ 手帳を提示した患者の算定割合\n（※③が「非該当」の場合のみ記入）",null,null,"前年５月から本年４月までの平均（小数点以下四捨五入）",null,"直近３ヶ月の平均(左記が50%以下の場合のみ記入（小数点以下四捨五入））"]
[null,"10.","かかりつけ薬剤師指導料及びかかりつけ薬剤師包括管理料"]
[null,"（※かかりつけ薬剤師指導料等を「届出している」と回答した場合に記入）",null,null,null,"① 令和６年５月から７月における勤務状況に基づき、当該薬局に勤務している全保険薬剤師の数\n　（非常勤の保険薬剤師は常勤換算）"]
[null,null,null,null,null,"② かかりつけ薬剤師指導料等に関する業務を行う保険薬剤師の数"]
[null,"〔記入上の注意〕"]
[1,"この報告書は、施設基準の届出を行った保険薬局ごとに提出すること。なお、休止の届出がされている場合は、当該報告書の提出は不要。指定がない項目については、令和６年８月１日時点の情報を記入すること。"]
[2,"印刷は、片面印刷を選択とすること。"]
[3,"訂正を行う場合は、二重線で削除し、訂正印は押さずに訂正すること。"]
[4,"オプションボタンが設けられている欄は、いずれかの区分を選択すること。\nチェックボックスが設けられている欄は、該当する区分に☑を記入すること。"]
[5,"保険薬剤師数、事務職員数には、８月１日現在に当該薬局に在籍する者を計上すること。\n・８月１日の欠勤者は在籍している人員について計上すること。なお、８月１日の採用者は計上するが、退職者は計上しない。\n"]
[6,"常勤換算については、下記の計算式により常勤換算数を計算し、それぞれの欄に記入すること。小数点以下第２位を四捨五入して小数点以下第１位までを計上すること。\n・常勤の職員の常勤換算数は「1.0人」とする。\n・常勤でない職員の常勤換算数は、以下の計算式により計算する。ただし、１人の従事者について、算出した数値が1.0を超える場合は、「1.0人」、0.1に満たない場合は「0.1人」として計算すること。\n・常勤換算数＝当該常勤でない職員の所定労働時間÷当該保険医療機関において定めている常勤職員の所定労働時間"]
[7,"「1.調剤基本料」欄の各項目は施設基準に定められた期間及び計算方法で算出される値を記入すること(別紙様式3参考を参照)。\nなお、定められた方法で計算できない項目については「０」と記入すること。"]
[8,"「1.調剤基本料」欄の④「同一グループ」の基準については、別紙様式3参考「第88の２　調剤基本料２」を参照のこと。"]
[9,"「1.調剤基本料」欄の⑥ウ ｢薬剤師のかかりつけ機能に係る基本的な業務を実施していない保険薬局への該当｣については、別紙様式3参考「 第91　調剤基本料の注４に規定する保険薬局」を参照のこと。"]
[10,"「5.後発医薬品調剤体制加算」欄の「②新指標の割合」及び「③カットオフ値の割合」の算出方法の考え方は、施設基準の届出に係るものと同様であること。\nただし、本年５月２日以降に新規指定の保険薬局等で直近3か月間の実績がない薬局については「① 本年５月２日以降に新規指定を受けた場合等、直近3か月間の実績がない保険薬局への該当」の該当を選択すること。\n\nその際、「後発医薬品の出荷停止等を踏まえた診療報酬上の臨時的な取扱いについて」（令和６年３月1８日事務連絡）の取扱いを行って算出した割合を記入しても差し支えない。\nこの場合、④の「②に「後発医薬品の出荷停止等を踏まえた診療報酬上の臨時的な取扱いについて」を適用した保険薬局への該当」欄の該当を選択すること。\n\n\n"]
[11,"（参考）\n・新指標の割合（直近３か月間の合計）\n　　後発医薬品の規格単位数量／後発医薬品あり先発医薬品及び後発医薬品の規格単位数量\n・カットオフ値の割合（直近３か月間の合計）\n　　後発医薬品あり先発医薬品及び後発医薬品の規格単位数量／全医薬品の規格単位数量\n\n"]
[12,"「5.後発医薬品調剤体制加算」欄の⑤「調剤基本料の注８」に規定する厚生労働大臣が定める保険薬局（後発医薬品の調剤数量割合が著しく低い薬局）に対する調剤基本料の減算規定の施設基準については、令和４年９月30日までの間に限り、なお従前の例による。（減算は５点が適用される）"]
[12,"（参考）調剤基本料の注８に規定する厚生労働大臣が定める保険薬局\n１ 以下のいずれかに該当する保険薬局は調剤基本料を５点減算する。ただし、処方箋受付回数が１月に600 回以下の保険薬局は除くものとする。\n(１) 当該保険薬局において調剤した後発医薬品のある先発医薬品及び後発医薬品について、当該薬剤を合算した規格単位数量に占める後発医薬品の規格単位数量の割合が50％以下であること。ただし、当該保険薬局における処方箋受付状況を踏まえ、やむを得ないものは除く。\n(２) 当該保険薬局において調剤した後発医薬品のある先発医薬品及び後発医薬品について、当該薬剤を合算した規格単位数量に占める後発医薬品の規格単位数量の割合について、毎年８月１日現在で届出書の記載事項について行う報告等を通じ、直近１年間に地方厚生（支）局長への報告をしていないこと。\n"]
[13,"「6.在宅薬学総合体制加算」欄の①について、「ア．がん末期などターミナルケアに対する体制」とは施設基準通知（２）アに適合する場合であり、「イ．小児在宅患者に対する体制」とは施設基準通知（２）イに適合する場合に、それぞれ☑を記載すること。\nまた、③及び④については、在宅薬学総合体制加算の届出の有無に関わらず、「在宅患者訪問薬剤管理指導料（在宅患者オンライン薬剤管理指導料を除く）」(医療保険)、「居宅療養管理指導費」及び「介護予防居宅療養管理指導費」(介護保険)（いずれも情報通信機器を用いた場合は除く）の算定回数及び実施患者数を、それぞれ記入すること。"]
[null,"「8．無菌製剤処理加算」の欄の②は、該当するもの全てに☑を記入すること。例えば、無菌室の中にクリーンベンチ設置している薬局の場合、無菌室とクリーンベンチの両方にチェックすること。"]
[14,"「9.服薬管理指導料」の欄の④「手帳を提示した患者の算定割合」は前年５月１日から本年４月末日までの服薬管理指導料の実績をもって該当性を判断すること。なお、実績がなく計算できない場合は「② 本年５月２日以降に新規指定を受けた場合等、直近3か月間の実績がない保険薬局への該当」の該当を選択すること。\n"]
[15,"「10.かかりつけ薬剤師指導料及びかかりつけ薬剤師包括管理料」欄の①「令和６年５月から７月における勤務状況に基づき、当該薬局に勤務している全保険薬剤師の数（非常勤の保険薬剤師は常勤換算）」については 、以下の（イ）及び（ロ）により小数点第二位を四捨五入して小数点第一位まで算出すること。（令和６年５月から７月において保険薬剤師の出入があった場合においても、勤務時間から常勤換算すること。）\n（イ）貴薬局における実労働時間が週32 時間以上である保険薬剤師は１名とする 。\n（ロ）貴薬局における実労働時間が週32 時間未満の保険薬剤師については、実労働時間を 32 時間で除した数とする。\n（例）Ａ保険薬剤師　１日４時間勤務を週５日　⇒週２０時間勤務\n　　　Ｂ保険薬剤師　１日５時間勤務を週６日　⇒週３０時間勤務\n\n　　　Ａ保険薬剤師　週２０時間÷３２時間＝０．６２５\n　　　Ｂ保険薬剤師　週３０時間÷３２時間＝０．９３７５\n　　　０．６２５＋０．９３７５＝１．５６２５　⇒１．６人"]
[16,"例年、以下の記入欄への記入漏れが多く見受けられるので、それ以外の項目も含め記入内容について提出前に改めて確認すること。\n　・｢薬局コード｣欄\n　・｢保険薬局名｣欄\n　・｢調剤基本料の注１ただし書きに規定する施設基準の保険薬局（医療資源の少ない地域に所在する保険薬局）への該当｣欄\n　・「遡及指定が認められた保険薬局への該当」欄\n　・「１⑤特定の保険医療機関と不動産の賃貸借取引等の有無」欄\n　・「１⑥調剤基本料の注４の減算への該当性」欄\n　・「３①備蓄医薬品数」欄\n　・「10①令和６年５月から７月における勤務状況に基づき、当該薬局に勤務している全保険薬剤師の数」欄"]

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["（別紙様式４－１）"]
["特別の療養環境の提供（入院医療に係るもの）に係る届出状況報告書（令和６年８月１日現在）"]
["都道府県名",null,{"$f":"IF(data!B1=\"\",\"\",VLOOKUP(data!B1,list!A3:C49,3,FALSE))","v":""},null,null,null,null,"医療機関コード　　　　　　　　　　　　　　　",null,{"$f":"IF(data!C1=\"\",\"\",data!C1)","v":""}]
[]
["保険医療機関名",null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""},null,null,null,null,"※レセプトに記載する７桁の数字を記載すること。"]
[]
[null,null,null,"　　　　　",null,"　　　　　",null,"　　　　",null,"　　　　",null,"　　　　　",null,"　　　　　"]
["開設者","　　　　　",null,"　　　　",null,"　　　　",null,"　　　　",null,"　　　　",null,"　　　　",null,"　　　　"]
["番号","　　　　",null,"　　　　",null,"　　　　",null,"　　　　",null,"　　　　",null,null,null,"　　　　"]
[null,"　　　　",null,"　　　　",null,"　　　　"]
[]
["　区　分","費用徴収を行うこととしている病床数（消費税を含む１日当たり金額階級別）",null,null,null,null,null,null,null,null,null,null,null,null,"費用徴収を行わない病床数"]
[null,"1,100円","1,101円","2,201円","3,301円","4,401円","5,501円","8,801円","11,001円","16,501円","33,001円","55,001円","110,001円","病床数\n小計"]
[null,null,"～","～","～","～","～","～","～","～","～","～"]
[null,"以下","2,200円","3,300円","4,400円","5,500円","8,800円","11,000円","16,500円","33,000円","55,000円","110,000円","以上"]
["個　室",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(SUM(B16:M17) = 0,0,SUM(B16:M17))","v":0}]
[]
["２人室",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(SUM(B18:M19) = 0,0,SUM(B18:M19))","v":0}]
[]
["３人室",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(SUM(B20:M21) = 0,0,SUM(B20:M21))","v":0}]
[]
["４人室",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(SUM(B22:M23) = 0,0,SUM(B22:M23))","v":0}]
[]
["５人室以上"]
[]
["病床数合計　",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"N16+N18+N20+N22","v":0},{"$f":"O16+O18+O20+O22+O24","v":0}]
[]
[]
["備　考","　　費用徴収を行うこととしている金額のうち最小の料金",null,null,null,null,null,null,null,null,"円（消費税含む。）"]
[]
[null,"　　費用徴収を行うこととしている金額のうち最大の料金",null,null,null,null,null,null,null,null,"円（消費税含む。）"]
[]
[]
["〔記載上の注意〕"]
["　１　この調査は、毎年８月１日現在における病床数の状況を記載すること。"]
["　２　「開設者番号」欄は、該当する番号を選択すること。"]
["　３　室とは、固定した隔壁で仕切られたものをいうものであること。(３人室をカーテン等で仕切り、それぞれ何人室と称しているときも、３人室とすること。)"]
["　４　室の区分における病床数は、現病床数によること。(個室であっても、現に２床を設けているときは、２人室として記載すること。)"]
["　５　患者を入院させることとしている病床で、８月１日現在空床であっても、この調査の対象となるものであること。"]
["　６　病床数小計①～④に関しては、費用徴収を行うこととしている区分(個室～４人室)ごとに、1,100円以下から110,001円以上の病床数の合計を記入すること。"]
["　　　（対象の病室がない場合は０を記入すること。）"]
["　７　⑤の病床数合計に関しては、病床数小計の①～④の病床数の合計を記載すること。"]
["　８　⑥～⑩に関しては、費用徴収を行わないこととしている区分(個室～５人室以上)ごとの病床数を記載すること。（対象の病室がない場合は０を記載すること。）"]
["　９　⑪の病床数合計に関しては、⑥～⑩の病床数の合計を記載すること。"]
["　10　特別の療養環境の提供（入院医療に係るもの）に係る特別の料金に事前の報告と相違がある場合は、速やかに変更の報告を行うこと。"]

{"sheet":"別紙様式４-２","index":9,"n_rows":30,"n_cols":14,"rows_kept":30,"cut":false,"hidden":false,"merged":[[4,0,4,1],[4,2,4,6],[1,0,1,14],[2,0,2,1],[2,2,2,3],[2,7,2,8],[2,9,2,12],[6,13,6,14],[7,1,7,2],[7,3,7,4],[7,5,7,6],[7,7,7,8],[7,9,7,10],[7,11,7,12],[7,13,7,14],[6,1,6,2],[6,3,6,4],[6,5,6,6],[6,7,6,8],[6,9,6,10],[6,11,6,12],[8,13,8,14],[9,1,9,2],[9,3,9,4],[9,5,9,6],[9,7,9,8],[9,9,9,10],[9,11,9,12],[9,13,9,14],[8,1,8,2],[8,3,8,4],[8,5,8,6],[8,7,8,8],[8,9,8,10],[8,11,8,12],[13,1,13,13],[13,14,16,14],[14,13,16,13],[17,0,18,0],[17,1,18,1],[17,2,18,2],[17,3,18,3],[17,4,18,4],[17,5,18,5],[17,6,18,6],[17,13,18,13],[17,10,18,10],[17,11,18,11],[17,12,18,12],[21,0,24,0],[21,8,21,9],[23,8,23,9],[17,7,18,7],[17,8,18,8],[17,9,18,9]]}
["（別紙様式４－２）"]
["特別の療養環境の提供（外来医療に係るもの）に係る届出状況報告書（令和６年８月１日現在）"]
["都道府県名",null,{"$f":"IF(data!B1=\"\",\"\",VLOOKUP(data!B1,list!A3:C49,3,FALSE))","v":""},null,null,null,null,"医療機関コード　　　　　　　　　　　　　　　",null,{"$f":"IF(data!C1=\"\",\"\",data!C1)","v":""}]
[]
["保険医療機関名",null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""},null,null,null,null,"※レセプトに記載する７桁の数字を記載すること。"]
[]
[null,null,null,"　　　　",null,"　　　　",null,"　　　　",null,"　　　　",null,"　　　　",null,"　　　　"]
["開設者","　　　　",null,"　　　　",null,null,null,"　　　　",null,"　　　　",null,"　　　　",null,"　　　　"]
["番号","　　　　",null,"　　　　",null,"　　　　",null,"　　　　",null,null,null,"　　　　"]
[]
[]
[]
[]
[null,"費用徴収を行うこととしている診察室数（消費税を含む１日当たり金額階級別）"]
[null,"1,100円","1,101円","2,201円","3,301円","4,401円","5,501円","8,801円","11,001円","16,501円","33,001円","55,001円","110,001円","合計"]
[null,null,"～","～","～","～","～","～","～","～","～","～"]
[null,"以下","2,200円","3,300円","4,400円","5,500円","8,800円","11,000円","16,500円","33,000円","55,000円","110,000円","以上"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(SUM(B18:M19)=0,\"\",SUM(B18:M19))","v":""}]
[]
[null,"※入院医療に係るものは別紙様式４－１に記載すること。"]
[]
["備　考","　　費用徴収を行うこととしている金額のうち最小の料金",null,null,null,null,null,null,null,null,"円（消費税含む。）"]
[]
[null,"　　費用徴収を行うこととしている金額のうち最大の料金",null,null,null,null,null,null,null,null,"円（消費税含む。）"]
[]
[]
["〔記載上の注意〕"]
["　１　この調査は、毎年８月１日現在における診察室数の状況を記載すること。（費用徴収を行うこととしている診察室がない場合は報告不要）"]
["　２　「開設者番号」欄は、該当する番号を選択すること。"]
["　３　特別の療養環境の提供（外来医療に係るもの）に係る特別の料金に事前の報告と相違がある場合は、速やかに変更の報告を行うこと。"]

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["（別紙様式５）",null,null,null,null,null,null,"（令和６年８月１日現在）"]
["選定療養及び歯科衛生実地指導等の実施状況報告書（歯科）"]
[]
[null,null,null,null,"　都道府県名",{"$f":"IF(data!B1=\"\",\"\",VLOOKUP(data!B1,list!A3:C49,3,FALSE))","v":""}]
[" ※ 休止の届出がされている場合は、当該報告書の提出は不要です。"]
["医療機関コード\n※レセプトに記載する７桁の数字を記載すること。",null,{"$f":"IF(data!C1=\"\",\"\",data!C1)","v":""}]
["保険医療機関の名称",null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[]
["〔記載上の注意〕\n１　前年８月１日から当年７月３１日までの間の診療実績に基づき、記載すること。\n２　期間内に①及び②の全項目について診療実績がない場合は、本報告書の提出は必要ないこと。\n３　期間内にいずれかの項目の診療実績がある場合は、診療実績欄の「有」を選択の上、当該保険医療機関において\n　実施した項目の金額又は人数のみ記載すること。①について各項目の価格を事前に報告している場合においても、\n  　診療実績がない項目には診療実績欄の「無」を選択の上、金額は記載しないこと。\n４　各項目の価格に事前の報告と相違がある場合は、速やかに変更の報告をすること。\n５　選定療養として地方厚生（支）局長に報告しておらず、一連の診療を全て自由診療とした場合における実績は報告対象としないこと。"]
[]
["【 ① 選定療養の実施状況 】"]
["１．金属床総義歯の実施状況",null,null,"診療実績(いずれか1つを選択)",null,null,"金額（消費税を含む）"]
["金属の種類毎の\n１床当たりの価格","白金加金","上顎",null,"※診療実績が「有」の場合は、右の欄にそれぞれの金額を記載すること。\n※診療実績が「無」の場合は、右の欄に金額を記載しないこと。",null,null,"円"]
[null,null,"下顎",null,null,null,null,"円"]
[null,"金合金","上顎",null,null,null,null,"円"]
[null,null,"下顎",null,null,null,null,"円"]
[null,"コバルトクロム合金","上顎",null,null,null,null,"円"]
[null,null,"下顎",null,null,null,null,"円"]
[null,"チタン合金","上顎",null,null,null,null,"円"]
[null,null,"下顎",null,null,null,null,"円"]
[null,"その他の金属","上顎",null,null,null,null,"円"]
[null,"","下顎",null,null,null,null,"円"]
[" ※　その他の金属欄は商品名ではなく、一般名を記載すること。\n"]
[]
["２．う蝕に罹患している患者の指導管理の実施状況",null,null,"診療実績(いずれか1つを選択)",null,null,"金額（消費税を含む）"]
["継続管理の種類","フッ化物局所応用（１口腔１回につき）",null,null,"※診療実績が「有」の場合は、右の欄にそれぞれの金額を記載すること。\n※診療実績が「無」の場合は、右の欄に金額を記載しないこと。",null,null,"円"]
[null,"小窩裂溝填塞（１歯につき）",null,null,null,null,null,"円"]
[" ※　選定療養として地方厚生（支）局長に報告し実施したものであること。\n"]
[]
[]
["３．前歯部の金属歯冠修復に使用する金合金又は白金加金の支給の\n　　実施状況",null,null,"診療実績(いずれか1つを選択)",null,null,"金額（消費税を含む）"]
["金合金（１歯につき）",null,null,null,"※診療実績が「有」の場合は、右の欄にそれぞれの金額を記載すること。\n※診療実績が「無」の場合は、右の欄に金額を記載しないこと。",null,null,"円"]
["白金加金（１歯につき）",null,null,null,null,null,null,"円"]
[" ※　前歯部の金属歯冠修復に使用する金合金又は白金加金とは、金属歯冠修復であって、その金属としては金合金又は白金加金を\n 　　用いたものであること。なお、硬質レジン前装冠に用いる金合金又は白金加金は対象としないこと。"]
[]
["【 ② 歯科衛生実地指導料又は訪問歯科衛生指導料の算定状況 】"]
["歯科衛生実地指導料又は\n訪問歯科衛生指導料",null,"算定実績","歯科衛生士数（実数）"]
[null,null,null,"常勤",null,null,"非常勤"]
[null,null,null,"※算定実績が「有」の場合のみ人数を記載すること。"]
[null,null,null,null,null,"人",null,"人"]
[" ※　歯科衛生実地指導料又は訪問歯科衛生指導料のいずれかを算定した実績がある場合は、令和６年８月１日時点の\n 　　常勤・非常勤それぞれの歯科衛生士数を記載すること。\n ※  実績がない場合は算定実績欄の「無」を選択した上、歯科衛生士数は記載しないこと。\n ※  令和６年８月１日時点で歯科衛生士数が０人であっても、前年８月１日から当年７月３１日までの間に診療実績がある\n     場合は、診療実績欄の「有」を選択した上、歯科衛生士数を０人と記載すること。　"]

{"sheet":"別紙様式６（１枚目）","index":11,"n_rows":30,"n_cols":11,"rows_kept":30,"cut":false,"hidden":false,"merged":[[2,0,2,10],[7,5,7,6],[7,7,7,10],[7,14,7,22],[9,0,9,1],[9,2,9,10],[14,8,18,8],[10,0,11,1],[10,2,10,3],[10,4,10,10],[11,4,11,6],[11,7,11,10],[12,0,13,1],[14,0,18,1],[14,3,18,3],[14,4,18,4],[14,5,18,6],[14,7,18,7],[29,0,29,7],[21,0,23,1],[21,5,21,6],[22,8,22,10],[23,3,23,4],[23,5,23,9],[24,0,26,1],[24,5,24,6],[25,8,25,10],[26,3,26,4],[26,5,26,9]]}
["（別紙様式６　１枚目）"]
[]
["初診等の保険外併用療養費届出状況報告書"]
[]
[null,"【注】様式は本紙含め２枚あります。必ず２枚記入してください。"]
[null,null,null,null,null,null,null,null,null,null,"（令和６年８月１日現在）"]
[]
[null,null,null,null,null,"都道府県名",null,{"$f":"IF(data!B1=\"\",\"\",VLOOKUP(data!B1,list!A3:C49,3,FALSE))","v":""}]
["１．医療機関の情報等について"]
["保険医療機関名",null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
["医療機関コード\n※レセプトに記載する７桁の数字を記載。\n（該当するものに☑、併設の場合は両方に☑、各コードを記入。）",null,"（チェック欄）",null,"（医療機関コード欄）"]
[null,null,false,false,"",null,null,""]
["報 告 種 別\n（該当するものを選択）"]
[]
["病 床 数",null,null,null,"床　　うち","一般病床",null,null,"床"]
[]
[]
[]
[]
[]
["２．特別の料金の徴収額について"]
["１．初診に係る特別の料金\n  （報告しているものに☑の上、\n　　料金額を記入）",null,null,false,null,false]
[null,null,null,null,"円（消費税含む）","／",null,null,"円（消費税含む）"]
[null,null,null,"時間帯別や年齢別など、\n特定の場合について\n別の額を設定している場合、\nその額及び要件。\n（上段と併せて記入）"]
["２．再診に係る特別の料金\n  （報告しているものに☑の上、\n　　料金額を記入）",null,null,false,null,false]
[null,null,null,null,"円（消費税含む）","／",null,null,"円（消費税含む）"]
[null,null,null,"時間帯別や年齢別など、\n特定の場合について\n別の額を設定している場合、\nその額及び要件。\n（上段と併せて記入）"]
[]
["　※初診や再診に係る特別の料金に事前の報告と相違がある場合は、速やかに変更の報告を行うこと。"]
["　※料金の設定を行っていない場合は「０」を記載すること。"]

{"sheet":"別紙様式６（２枚目）","index":12,"n_rows":44,"n_cols":10,"rows_kept":44,"cut":false,"hidden":false,"merged":[[13,1,14,5],[13,6,13,7],[13,8,13,9],[1,6,1,7],[2,6,2,7],[2,8,2,9],[3,6,3,7],[3,8,3,9],[5,1,6,5],[5,6,5,7],[5,8,5,9],[7,2,7,5],[8,3,8,5],[9,4,9,5],[10,4,10,5],[12,0,12,9],[26,3,26,5],[15,1,15,5],[16,3,16,5],[17,3,17,5],[18,3,18,5],[19,3,19,5],[20,3,20,5],[21,1,21,5],[22,3,22,5],[23,3,23,5],[24,3,24,5],[25,3,25,5],[42,3,42,9],[27,3,27,5],[28,3,28,5],[29,3,29,5],[30,3,30,5],[31,3,31,5],[32,1,32,5],[33,1,33,5],[35,1,35,9],[36,3,36,5],[37,3,37,5],[38,3,38,5]]}
["（別紙様式６　２枚目）"]
[null,null,null,null,null,null,"医療機関コード"]
[null,null,null,null,null,null,"医科",null,{"$f":"IF('別紙様式６（１枚目）'!E12=\"\",\"\",TRIM('別紙様式６（１枚目）'!E12))","v":""}]
["　　　",null,null,null,null,null,"歯科",null,{"$f":"IF('別紙様式６（１枚目）'!H12=\"\",\"\",TRIM('別紙様式６（１枚目）'!H12))","v":""}]
["３．初診等に係る特別の料金の徴収状況等について"]
[null,null,null,null,null,null,"初診",null,"再診"]
[null,null,null,null,null,null,"医科（名）","歯科（名）","医科（名）","歯科（名）"]
[null,"①","初診又は再診の患者数"]
[null,null,"②","①のうち、紹介状なしの患者又は他の保険医療機関を紹介したにもかかわらず、自院を受診した患者数"]
[null,null,null,"③","②のうち、特別の料金を徴収した患者数"]
[null,null,null,"④","②のうち、特別の料金を徴収しなかった患者数",null,{"$f":"IFERROR(IF(G9=\"\",\"\",G9-G10),\"\")","v":""},{"$f":"IFERROR(IF(H9=\"\",\"\",H9-H10),\"\")","v":""},{"$f":"IFERROR(IF(I9=\"\",\"\",I9-I10),\"\")","v":""},{"$f":"IFERROR(IF(J9=\"\",\"\",J9-J10),\"\")","v":""}]
[]
["４．初診等に係る特別の料金を徴収しなかった患者（３の④）の内訳について\n　注：患者が(1)及び(2)に該当する場合は(1)に記載してください。\n　　　(1）①～⑤、(2)①～⑩については、それぞれに該当した人数を記載してください（複数回答可）。\n　　　（2）（3）を記載する場合、特定機能病院、地域医療支援病院及び紹介受診重点医療機関については、 （1）（2）（3）の\n　　　合計が3.④の数と等しくなるよう、ご注意ください。"]
[null,null,null,null,null,null,"初診",null,"再診"]
[null,null,null,null,null,null,"医科（名）","歯科（名）","医科（名）","歯科（名）"]
[null,"（１）特別の料金の徴収を行うことは認められない患者"]
[null,null,"①","救急の患者"]
[null,null,"②","国の公費負担医療制度の受給対象者"]
[null,null,"③","地方単独の公費負担医療の受給対象者（事業の趣旨が特定の障害、特定の疾病等に着目しているものに限る）"]
[null,null,"④","無料低額診療事業実施医療機関における当該制度の対象者"]
[null,null,"⑤","エイズ拠点病院におけるＨＩＶ感染者"]
[null,"(２）特別の料金の支払いを求めないことができる患者（※２）"]
[null,null,"①","自施設の他の診療科を受診している患者"]
[null,null,"②","医科と歯科との間で院内紹介された患者"]
[null,null,"③","特定健康診査、がん検診等の結果により精密検査受診の指示を受けた患者"]
[null,null,"④","救急医療事業、周産期事業等における休日夜間受診患者"]
[null,null,"⑤","外来受診から継続して入院した患者"]
[null,null,"⑥","地域に他に当該診療科を標榜する保険医療機関がなく、当該保険医療機関が外来診療を実質的に担っているような診療科を受診する患者"]
[null,null,"⑦","治験協力者である患者"]
[null,null,"⑧","災害により被害を受けた患者"]
[null,null,"⑨","労働災害、公務災害、交通事故、自費診療の患者"]
[null,null,"⑩","その他、保険医療機関が当該保険医療機関を直接受診する必要性を特に認めた患者\n（（４）に具体的な理由及び患者数を記載すること）"]
[null,"（３）（１）及び（２）以外の理由により特別の料金を徴収しなかった患者（説明をしても同意 が得られなかった患者等）（※２）"]
[null,"合計",null,null,null,null,{"$f":"SUM(G16,G22,G33)","v":0},{"$f":"SUM(H16,H22,H33)","v":0},0,0]
[]
[null,"（４）（２）の⑩の具体的な理由及び患者数（主な理由及び当該事例により特別の料金を徴収しなかった患者数等を記載（上位３つ））（※２）"]
[null,null,1,""]
[null,null,2,""]
[null,null,3,""]
[]
[null,"［記載上の注意］"]
[null,"※１　",null,"３から４については、前年度（令和５年４月１日～令和６年３月31日）の実施状況を記載すること。"]
[null,"※２　",null,"特定機能病院、地域医療支援病院及び紹介受診重点医療機関以外の病院については、可能な範囲で（２）～（４）\nを記載すること。"]
[null,"※３",null,"患者数については、延べ人数を記載すること。"]

{"sheet":"別紙様式７","index":13,"n_rows":12,"n_cols":11,"rows_kept":12,"cut":false,"hidden":false,"merged":[[1,4,1,6],[1,7,1,10],[2,4,2,6],[2,7,2,10],[3,4,3,6],[3,7,3,10],[9,1,9,4],[9,5,9,7],[11,0,12,10],[5,0,5,10],[6,0,6,10],[7,1,7,4],[7,5,7,10],[8,1,8,4],[8,5,8,7]]}
[]
[null,null,null,null,"医療機関コード",null,null,{"$f":"IF(data!C1=\"\", \"\", data!C1)","v":""}]
[null,null,null,null,"保険医療機関名",null,null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[null,null,null,null,"病院・診療所の区分\n（該当するものを選択）"]
[null,null,null,null,null,null,null,null,null,null,"令和６年８月１日現在"]
["「予約に基づく診察」及び「保険医療機関が表示する"]
["診療時間以外の時間における診察」の実施報告書"]
["区分","項目",null,null,null,"患者からの徴収額（消費税を含む）"]
[null,"予約に基づく診療",null,null,null,"・予約料"]
[null,"保険医療機関が表示する診療時間以外の時間における診察",null,null,null,"・患者からの徴収額"]
["［記載上の注意］"]
["・保険外併用療養費の報告を行っている「区分」欄に「○」を記入し、「患者からの徴収額」欄に金額を記入すること。"]

{"sheet":"別紙様式８","index":14,"n_rows":34,"n_cols":7,"rows_kept":34,"cut":false,"hidden":false,"merged":[[2,0,2,6],[3,1,3,6],[5,3,5,4],[5,5,5,6],[7,3,7,4],[7,5,7,6],[9,3,9,4],[9,5,9,6],[11,1,12,1],[11,2,12,3],[11,4,12,5],[11,6,12,6],[18,0,20,0],[18,2,18,3],[18,4,18,5],[19,2,19,3],[19,4,19,5],[20,2,20,3],[20,4,20,5],[13,0,17,0],[13,2,13,3],[13,4,13,5],[14,2,14,3],[14,4,14,5],[15,2,15,3],[15,4,15,5],[16,2,16,3],[16,4,16,5],[17,2,17,3],[17,4,17,5],[25,1,25,6],[27,0,27,6],[21,0,23,0],[21,2,21,3],[21,4,21,5],[22,2,22,3],[22,4,22,5],[23,2,23,3],[23,4,23,5]]}
["（別紙様式８）",null,null,null,null,null,"（令和６年８月１日現在）"]
[]
["180日を超える入院に関する事項の実施状況報告書"]
[null,"　（徴収した実績がない場合は報告の必要はない）"]
[]
[null,null,null,"都道府県名",null,{"$f":"IF(data!B1=\"\",\"\",VLOOKUP(data!B1,list!A3:C49,3,FALSE))","v":""}]
[]
[null,null,null,"医療機関コード",null,{"$f":"IF(data!C1=\"\",\"\",data!C1)","v":""}]
[null,null,null,"　※レセプトに記載する７桁の数字を記載すること。"]
[null,null,null,"保険医療機関名",null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[]
["＜病院＞","区分\n注１","対象者数\n（実数）",null,"特別の料金を徴収した\n延べ日数",null,"患者から徴収した料金\n（１人１日当たり）注３"]
["入院料"]
["一般病棟入院基本料",""]
[null,""]
[null,""]
[null,""]
[null,""]
["特定機能病院入院基本料",""]
[null,""]
[null,""]
["専門病院入院基本料",""]
[null,""]
[null,""]
["注２"]
[null,""]
["〔記載上の注意〕"]
["　１．該当する番号を記載すること。\n　　　　１　急性期一般入院料１　　　　　８　地域一般入院料１　　　　　１５　１０対１入院基本料　　　\n　　　　２　急性期一般入院料２　　　　　９　地域一般入院料２　　　　　１６　１３対１入院基本料\n　　　　３　急性期一般入院料３　　　　１０　地域一般入院料３\n　　　　４　急性期一般入院料４　　　　１１　特別入院基本料\n　　　　５　急性期一般入院料５　　　　１２　月平均夜勤時間超過減算\n　　　　６　急性期一般入院料６　　 　 １３　夜勤時間特別入院基本料\n　　　　７　急性期一般入院料７      　１４　７対１入院基本料"]
[]
[]
["　２．本報告については、直近１年間（前年８月１日～当年７月３１日）の実施状況を記載すること。"]
["　　　なお、徴収した実績がない場合は報告の必要はない。"]
[]
["　３．180日を超える入院に係る特別の料金に事前の報告と相違がある場合は、速やかに変更の報告を行うこと。"]

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[]
[null,null,null,null,null,"医療機関コード",null,null,{"$f":"IF(data!C1=\"\", \"\", data!C1)","v":""}]
[null,null,null,null,null,"保険医療機関名",null,null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,"令和６年８月１日現在"]
["医科点数表等に規定する回数を超えて受けた診療の実施報告書"]
["区分","項目",null,null,null,null,"患者からの徴収額（消費税を含む）"]
[null,"医科点数表等に規定する回数を超えて受けた診療"]
[null,"検査","・α－フェトプロテイン（ＡＦＰ）",null,null,null,"・患者からの徴収額"]
[null,null,"・癌胎児性抗原（ＣＥＡ）",null,null,null,"・患者からの徴収額"]
[null,null,"・前立腺特異抗原（ＰＳＡ）",null,null,null,"・患者からの徴収額"]
[null,null,"・ＣＡ19－9",null,null,null,"・患者からの徴収額"]
[null,"リハビリテーション","・心リハ（Ⅰ）",null,null,null,"・患者からの徴収額"]
[null,null,"・心リハ（Ⅱ）",null,null,null,"・患者からの徴収額"]
[null,null,"・脳リハ（Ⅰ）",null,null,null,"・患者からの徴収額"]
[null,null,"・脳リハ（Ⅱ）",null,null,null,"・患者からの徴収額"]
[null,null,"・脳リハ（Ⅲ）",null,null,null,"・患者からの徴収額"]
[null,null,"・廃用リハ（Ⅰ）",null,null,null,"・患者からの徴収額"]
[null,null,"・廃用リハ（Ⅱ）",null,null,null,"・患者からの徴収額"]
[null,null,"・廃用リハ（Ⅲ）",null,null,null,"・患者からの徴収額"]
[null,null,"・運リハ（Ⅰ）",null,null,null,"・患者からの徴収額"]
[null,null,"・運リハ（Ⅱ）",null,null,null,"・患者からの徴収額"]
[null,null,"・運リハ（Ⅲ）",null,null,null,"・患者からの徴収額"]
[null,null,"・呼リハ（Ⅰ）",null,null,null,"・患者からの徴収額"]
[null,null,"・呼リハ（Ⅱ）",null,null,null,"・患者からの徴収額"]
[null,"精　神　科　専　門　療　法","・ショート・ケア（大）",null,null,null,"・患者からの徴収額"]
[null,null,"・ショート・ケア（小）",null,null,null,"・患者からの徴収額"]
[null,null,"・デイ・ケア（大）",null,null,null,"・患者からの徴収額"]
[null,null,"・デイ・ケア（小）",null,null,null,"・患者からの徴収額"]
[null,null,"・ナイト・ケア",null,null,null,"・患者からの徴収額"]
[null,null,"・デイ・ナイト・ケア",null,null,null,"・患者からの徴収額"]
["［記載上の注意］"]
["・保険外併用療養費の報告を行っている「区分」欄に「○」を記入し、「患者からの徴収額」欄に金額を記入すること。"]

{"sheet":"別紙様式１０","index":16,"n_rows":44,"n_cols":14,"rows_kept":44,"cut":false,"hidden":false,"merged":[[43,2,44,13],[30,1,31,7],[30,8,31,8],[30,9,31,13],[33,2,33,7],[33,10,33,13],[34,2,34,7],[34,10,34,13],[28,1,29,7],[28,8,29,8],[28,9,29,13],[37,2,38,13],[39,2,42,13],[26,9,27,13],[19,1,20,7],[19,8,20,8],[19,9,20,13],[21,1,23,7],[21,8,23,8],[21,9,23,13],[24,1,25,7],[24,8,25,8],[24,9,25,13],[26,1,27,7],[26,8,27,8],[15,1,16,7],[15,8,16,8],[15,9,16,13],[17,1,18,7],[17,8,18,8],[17,9,18,13],[11,1,12,7],[11,8,12,8],[11,9,12,13],[13,1,14,7],[13,8,14,8],[13,9,14,13],[2,1,2,13],[4,4,4,6],[4,7,4,13],[5,4,5,6],[5,7,5,13],[6,4,6,6],[8,1,8,7],[8,8,9,8],[8,9,9,13],[9,1,9,7]]}
[null,"別紙様式１０"]
[]
[null,"ニコチン依存症管理料に係る報告書"]
[]
[null,null,null,null,"保険医療機関名",null,null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[null,null,null,null,"医療機関コード",null,null,{"$f":"IF(data!C1=\"\", \"\", data!C1)","v":""}]
[null,null,null,null,"報告年月日",null,null,"令和",null,"年",null,"月",null,"日"]
[]
[null,"本管理料を算定した患者数",null,null,null,null,null,null,"①"]
[null,"　（期間：令和５年４月～令和６年３月）"]
[]
[null,"①のうち、当該期間後の７月末日までに１２週間にわたる計５回の禁煙治療を終了した者",null,null,null,null,null,null,"②"]
[]
[null,"②のうち、禁煙に成功した者",null,null,null,null,null,null,"③"]
[]
[null,"５回の指導を最後まで行わずに治療を中止した者（①－②）のうち、中止時に禁煙していた者",null,null,null,null,null,null,"④"]
[]
[null,"ニコチン依存症管理料１のイに掲げる初回の治療の算定回数\n（令和５年４月１日から令和６年３月末日までの一年間）",null,null,null,null,null,null,"⑤"]
[]
[null,"ニコチン依存症管理料２の算定回数\n（令和５年４月１日から令和６年３月末日までの一年間）",null,null,null,null,null,null,"⑥"]
[]
[null,"ニコチン依存症管理料１の一年間の延べ算定回数\n（令和５年４月１日から令和６年３月末日までの一年間における初回から５回目までの治療を含む）",null,null,null,null,null,null,"⑦"]
[]
[]
[null,"ニコチン依存症管理料２を算定した患者の延べ指導回数\n（令和５年４月１日から令和６年３月末日までの一年間）",null,null,null,null,null,null,"⑧"]
[]
[null,"①のうち、禁煙治療補助システム指導管理加算を\n算定したもの",null,null,null,null,null,null,"⑨"]
[]
[null,"②のうち、禁煙治療補助システム指導管理加算を\n算定したもの",null,null,null,null,null,null,"⑩"]
[]
[null,"③のうち、禁煙治療補助システム指導管理加算を\n算定したもの",null,null,null,null,null,null,"⑪"]
[]
[]
[null,null,"　・喫煙を止めたものの割合＝（③＋④）／①",null,null,null,null,null,null,null,{"$f":"IFERROR(IF(OR(J9=\"\",J14=\"\",J16=\"\"),\"\",((J14+J16)/J9)*100),\"\")","v":""}]
[null,null,"　・治療の平均継続回数＝(⑦＋⑧)／(⑤＋⑥）",null,null,null,null,null,null,null,{"$f":"IFERROR(IF(OR(J22=\"\",J25=\"\",J18=\"\",J20=\"\"),\"\",(J22+J25)/(J18+J20)),\"\")","v":""}]
[]
[null,"［記載上の注意点］"]
[null,1,"　「本管理料を算定した患者数」欄は、ニコチン依存症管理料１の初回点数及びニコチン依存症管理料２を算定した患者数の合計を計上すること。"]
[]
[null,2,"　「②のうち、禁煙に成功した者」欄は、１２週間にわたる計５回の禁煙治療の終了時点で、４週間以上の禁煙に成功している者を計上すること。\n　なお、禁煙の成功を判断する際には、呼気一酸化炭素濃度測定器を用いて喫煙の有無を確認すること。"]
[]
[]
[]
[null,3,"　①が５人以下である場合は、令和６年３月に初回の治療を行った患者を、⑤から除くことができる。"]

{"sheet":"別紙様式１１-１（診療所）","index":17,"n_rows":63,"n_cols":18,"rows_kept":63,"cut":false,"hidden":false,"merged":[[62,2,62,17],[55,1,55,17],[56,1,56,17],[57,1,57,17],[58,2,58,8],[53,2,53,13],[53,14,53,17],[52,2,52,13],[49,2,49,13],[60,1,60,17],[52,14,52,17],[59,2,59,8],[58,10,58,12],[59,13,59,15],[59,10,59,12],[49,14,49,17],[50,14,50,17],[51,2,51,13],[51,14,51,17],[32,1,32,17],[33,1,33,17],[35,1,35,17],[36,1,36,8],[36,9,36,12],[36,13,36,17],[37,1,37,8],[42,2,42,7],[42,8,42,12],[42,13,42,17],[37,9,37,12],[37,13,37,17],[38,1,38,8],[38,9,38,12],[38,13,38,17],[40,1,40,17],[41,2,41,17],[48,1,48,17],[43,2,43,7],[43,8,43,12],[43,13,43,17],[46,8,46,12],[46,13,46,17],[47,2,47,7],[47,8,47,12],[47,13,47,17],[44,2,44,7],[44,8,44,12],[44,13,44,17],[45,2,45,7],[45,8,45,12],[45,13,45,17],[46,2,46,7],[30,1,30,5],[30,6,30,8],[30,9,30,11],[30,12,30,14],[30,15,30,17],[31,1,31,5],[31,6,31,8],[31,9,31,11],[31,12,31,14],[31,15,31,17],[28,15,29,17],[29,9,29,11],[20,14,20,16],[21,14,21,16],[22,14,22,16],[16,2,21,2],[21,4,21,9],[21,10,21,12],[28,1,29,5],[28,6,29,8],[28,12,29,14],[25,1,25,17],[15,1,22,1],[15,2,15,9],[15,10,15,12],[18,14,18,16],[27,1,27,17],[20,4,20,9],[20,10,20,12],[19,3,19,9],[19,10,19,12],[19,14,19,16],[22,2,22,12],[23,1,23,17],[1,1,1,4],[1,14,1,17],[2,1,2,17],[3,1,3,17],[5,9,5,11],[16,3,16,9],[16,14,16,16],[17,14,17,16],[18,4,18,9],[18,10,18,12],[16,10,16,12],[17,4,17,9],[17,10,17,12],[15,14,15,16],[13,14,13,16],[13,1,13,4],[14,1,14,12],[6,9,6,11],[6,12,6,17],[8,5,8,9],[24,1,24,17],[14,14,14,16],[8,10,9,17],[9,5,9,9],[10,5,10,9],[10,11,10,13],[10,14,10,17],[13,5,13,12],[5,12,5,17],[11,1,11,17],[12,1,12,17]]}
[]
[null,"（別紙様式１１－１）"]
[null,"在 宅 療 養 支 援 診 療 所 に 係 る 報 告 書"]
[null,"（ 令和6年8月1日現在 ）"]
[]
[null,null,null,null,null,null,null,null,null,"保険医療機関名",null,null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[null,null,null,null,null,null,null,null,null,"医療機関コード",null,null,{"$f":"IF(data!C1=\"\", \"\", data!C1)","v":""}]
[]
[null,null,null,null,null,"別添１の「第9の1」の１の（１）",null,null,null,null,"\nに規定する在宅療養支援診療所\n　　※ 届出している区分のいずれかを選択してください。"]
[null,null,null,null,null,"別添１の「第9の1」の１の（２）"]
[null,null,null,null,null,"別添１の「第9の1」の１の（３）",null,null,null,null,null,"実績加算届出"]
[]
[null,"Ⅰ．直近１年間（令和5年8月1日～令和6年7月31日）に在宅療養を担当した患者について"]
[null,"１　平均診療期間",null,null,null,"※在宅医療を開始してからの診療期間を患者ごとに算出 〔 在宅医療の開始月と終了月をそれぞれ算入のこと。 （期間が月を跨っている場合は2ヶ月と計算する。） 〕し、保険医療機関における平均診療期間を月単位で計上してください。",null,null,null,null,null,null,null,"(",null,null,null,"ヶ月　)"]
[null,"２　合計診療患者数",null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,"人　)"]
[null,null,"　【再掲】 死亡患者数",null,null,null,null,null,null,null,"①＋②＋③＋④",null,null,"(",{"$f":"IF(OR(O18=\"\",O19=\"\",O21=\"\",O22=\"\"),\"\",(O18+O19+O21+O22))","v":""},null,null,"人　)"]
[null,null,null," （１） うち医療機関以外での死亡者数",null,null,null,null,null,null,"①＋②",null,null,"(",{"$f":"IF(OR(O19=\"\",O19=\"\"),\"\",(O18+O19))","v":""},null,null,"人　)"]
[null,null,null,null,"　ア　うち自宅での死亡者数",null,null,null,null,null,"①",null,null,"(",null,null,null,"人　)"]
[null,null,null,null,"　イ　うち自宅以外での死亡者数",null,null,null,null,null,"②",null,null,"(",null,null,null,"人　)"]
[null,null,null," （２） うち医療機関での死亡者数",null,null,null,null,null,null,"③＋④",null,null,"(",{"$f":"IF(OR(O22=\"\",O22=\"\"),\"\",(O21+O22))","v":""},null,null,"人　)"]
[null,null,null,null,"　ア　うち連携医療機関での死亡者数",null,null,null,null,null,"③",null,null,"(",null,null,null,"人　)"]
[null,null,null,null,"　イ　うち連携医療機関以外での死亡者数",null,null,null,null,null,"④",null,null,"(",null,null,null,"人　)"]
[null,null,"超重症児又は準超重症児の患者数\n（15歳未満であって、3回以上定期的な訪問診療を実施し、在宅時医学総合管理料又は施設入居時等医学総合管理料を算定したものに限る。）",null,null,null,null,null,null,null,null,null,null,"(",null,null,null,"人　)"]
[]
[null,"Ⅰの２（１）の「うち医療機関以外での死亡者数」を記入するに当たり、介護老人保健施設等の入所施設で死亡した患者については「イ　うち自宅以外での死亡者数」欄へ計上してください。"]
[null,"Ⅰの２（２）の「連携医療機関」とは、事前に緊急時の受入を届出ている医療機関であり、在宅支援連携体制についても含むものです。"]
[]
[null,"Ⅱ．直近１年間（令和5年8月1日～令和6年7月31日）の訪問診療等の実施回数について"]
[null,"訪問診療等の合計回数",null,null,null,null,"（１） 往診",null,null,null,null,null,"（２）訪問診療",null,null,"（３）訪問看護\n（緊急を含む）"]
[null,null,null,null,null,null,null,null,null,"【再掲】\nうち緊急の往診"]
[null,"　①＋②＋③",null,null,null,null,"　①",null,null,null,null,null,"　②",null,null,"　③"]
[null,{"$f":"IF(OR(G32=\"\",M32=\"\",P32=\"\"),\"\",(G32+M32+P32))","v":""}]
[]
[null,"Ⅱの「うち緊急の往診」については、緊急又は夜間・休日若しくは深夜に行った往診を計上してください。"]
[]
[null,"　Ⅲ．直近1ヶ月間（令和6年7月）における往診又は訪問診療の状況について"]
[null,"①　初診、再診、往診又は訪問診療を実施した患者数"]
[null,"②　往診又は訪問診療を実施した患者数"]
[null,"③　往診又は訪問診療を実施した患者の割合(②／①)",null,null,null,null,null,null,null,{"$f":"IF(ISERROR(J38/J37), \"\", ROUNDDOWN(J38/J37*100, 2))","v":""},null,null,null,"小数点第3位を切り捨て（95％以上は「Ⅳ」を記載）"]
[]
[null,"　Ⅳ．主として往診又は訪問診療を実施する診療所に係る状況（Ⅲの３が95％以上の医療機関は記入すること）"]
[null,"１\n","直近１年間（令和5年8月1日から令和6年7月31日）に、訪問診療を開始した患者の紹介（文書によるものに限る。）を受けた保険医療機関"]
[null,null,"保険医療機関の名称",null,null,null,null,null,"患者の紹介を行った医師",null,null,null,null,"患者の紹介を受けた日付"]
[null,"①","",null,null,null,null,null,"",null,null,null,null,""]
[null,"②","",null,null,null,null,null,"",null,null,null,null,""]
[null,"③","",null,null,null,null,null,"",null,null,null,null,""]
[null,"④","",null,null,null,null,null,"",null,null,null,null,""]
[null,"⑤","",null,null,null,null,null,"",null,null,null,null,""]
[null,"　２　直近１月間（令和6年7月1日から令和6年7月31日）の診療実績"]
[null,"①","在宅時医学総合管理料を算定した患者数"]
[null,"②","施設入居時等医学総合管理料を算定した患者数"]
[null,"③","①及び②のうち、要介護３以上又は別表第八の二に規定する別に厚生労働大臣が定める状態に該当する患者数"]
[null,"④","施設入居時等医学総合管理料を算定した患者の割合②／（①＋②）",null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(ISERROR(O51/(O$50+O$51)),\"\",ROUNDDOWN(O51/(O$50+O$51)*100,2))","v":""}]
[null,"⑤","要介護３又は別表第八の二に規定する別に厚生労働大臣が定める状態に該当する患者の割合  ③／（①＋②)",null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(ISERROR(O52/(O$50+O$51)),\"\",ROUNDDOWN(O52/(O$50+O$51)*100,2))","v":""}]
[]
[null,"※　以下の欄は「別添１の「第9の1」の１の（２）」に規定する在宅療養支援診療所のみ記入してください。"]
[]
[null,"Ⅴ．在宅支援連携体制について"]
[null,1,"在宅医療を担当する常勤の医師数",null,null,null,null,null,null,"（",null,null,null,"人　）"]
[null,2,"連携する保険医療機関数",null,null,null,null,null,null,"(",null,null,null,"医療機関　）"]
[null,"Ⅴの「在宅支援連携体制について」を記載するに当たっては、自院を含めた数を記載してください。"]
[]
[null,"※","「別添１の「第9の1」の１の（2）」に規定する在宅療養支援診療所のうち、連携する医療機関の実績を取りまとめる医療機関は、別紙様式１１の４「在宅支援連携体制に係る報告書」もあわせて記入し、報告書を提出してください。"]

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[]
[null,"（別紙様式１１－１）"]
[null,"在 宅 療 養 支 援 病 院 に 係 る 報 告 書"]
[null,"（ 令和6年8月1日現在 ）"]
[]
[null,null,null,null,null,null,null,null,null,"保険医療機関名",null,null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[null,null,null,null,null,null,null,null,null,"医療機関コード",null,null,{"$f":"IF(data!C1=\"\", \"\", data!C1)","v":""}]
[]
[null,null,null,null,null,"別添１の「第14の2」の１の（１）",null,null,null,null,"に規定する在宅療養支援病院\n　　※ 届出している区分のいずれかを選択してください。"]
[null,null,null,null,null,"別添１の「第14の2」の１の（２）"]
[null,null,null,null,null,"別添１の「第14の2」の１の（３）"]
[]
[null,"Ⅰ．直近１年間（令和5年8月1日～令和6年7月31日）に在宅療養を担当した患者について"]
[null,"１　平均診療期間",null,null,null,"※在宅医療を開始してからの診療期間を患者ごとに算出 〔 在宅医療の開始月と終了月をそれぞれ算入のこと。 （期間が月を跨っている場合は2ヶ月と計算する。） 〕し、保険医療機関における平均診療期間を月単位で計上してください。",null,null,null,null,null,null,null,"(",null,null,null,"ヶ月　)"]
[null,"２　合計診療患者数",null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,"人　)"]
[null,null,"　【再掲】 死亡患者数",null,null,null,null,null,null,null,"①＋②＋③＋④",null,null,"(",{"$f":"IF(OR(O18=\"\",O19=\"\",O21=\"\",O22=\"\"),\"\",(O18+O19+O21+O22))","v":""},null,null,"人　)"]
[null,null,null," （１） うち医療機関以外での死亡者数",null,null,null,null,null,null,"①＋②",null,null,"(",{"$f":"IF(OR(O19=\"\",O19=\"\"),\"\",(O18+O19))","v":""},null,null,"人　)"]
[null,null,null,null,"　ア　うち自宅での死亡者数",null,null,null,null,null,"①",null,null,"(",null,null,null,"人　)"]
[null,null,null,null,"　イ　うち自宅以外での死亡者数",null,null,null,null,null,"②",null,null,"(",null,null,null,"人　)"]
[null,null,null," （２） うち医療機関での死亡者数",null,null,null,null,null,null,"③＋④",null,null,"(",{"$f":"IF(OR(O22=\"\",O22=\"\"),\"\",(O21+O22))","v":""},null,null,"人　)"]
[null,null,null,null,"　ア　うち連携医療機関での死亡者数",null,null,null,null,null,"③",null,null,"(",null,null,null,"人　)"]
[null,null,null,null,"　イ　うち連携医療機関以外での死亡者数",null,null,null,null,null,"④",null,null,"(",null,null,null,"人　)"]
[null,null,"超重症児又は準超重症児の患者数\n（15歳未満であって、3回以上定期的な訪問診療を実施し、在宅時医学総合管理料又は施設入居時等医学総合管理料を算定したものに限る。）",null,null,null,null,null,null,null,null,null,null,"(",null,null,null,"人　)"]
[]
[null,"Ⅰの２（１）の「うち医療機関以外での死亡者数」を記入するに当たり、介護老人保健施設等の入所施設で死亡した患者については「イ　うち自宅以外での死亡者数」欄へ計上してください。"]
[null,"Ⅰの２（２）の「連携医療機関」とは、事前に緊急時の受入を届出ている医療機関であり、在宅支援連携体制についても含むものです。"]
[]
[null,"Ⅱ．直近１年間（令和5年8月1日～令和6年7月31日）の訪問診療等の実施回数について"]
[null,"訪問診療等の合計回数",null,null,null,null,"（１） 往診",null,null,null,null,null,"（２）訪問診療",null,null,"（３）訪問看護\n（緊急を含む）"]
[null,null,null,null,null,null,null,null,null,"【再掲】\nうち緊急の往診"]
[null,"　①＋②＋③",null,null,null,null,"　①",null,null,null,null,null,"　②",null,null,"　③"]
[null,{"$f":"IF(OR(G32=\"\",M32=\"\",P32=\"\"),\"\",(G32+M32+P32))","v":""}]
[]
[null,"Ⅱの「うち緊急の往診」については、緊急又は夜間・休日若しくは深夜に行った往診を計上してください。"]
[]
[null,"※　以下の欄は「別添１の「第14の2」の１の（２）」に規定する在宅療養支援病院のみ記入してください。"]
[]
[null,"Ⅲ．在宅支援連携体制について"]
[null,1,"在宅医療を担当する常勤の医師数",null,null,null,null,null,null,"（",null,null,null,"人　）"]
[null,2,"連携する保険医療機関数",null,null,null,null,null,null,"(",null,null,null,"医療機関　）"]
[]
[null,"Ⅲの「在宅支援連携体制について」を記載するに当たっては、自院を含めた数を記載してください。"]
[]
[null,"※","「別添１の「第9の1」の１の（2）」に規定する在宅療養支援病院のうち、連携する医療機関の実績を取りまとめる医療機関は、別紙様式１１の４「在宅支援連携体制に係る報告書」もあわせて記入し、報告書を提出してください。"]

{"sheet":"別紙様式１１-２（診療所）","index":19,"n_rows":40,"n_cols":18,"rows_kept":40,"cut":false,"hidden":false,"merged":[[1,1,1,4],[1,14,1,17],[2,1,2,17],[3,1,3,17],[5,9,5,11],[5,12,5,17],[13,14,13,16],[14,14,14,16],[15,14,15,16],[13,10,13,12],[17,3,17,9],[17,10,17,12],[14,3,14,9],[14,10,14,12],[15,10,15,12],[16,4,16,9],[16,14,16,16],[17,14,17,16],[6,12,6,17],[7,1,7,17],[8,1,8,17],[10,1,10,17],[12,14,12,16],[11,14,11,16],[11,1,11,4],[11,5,11,12],[6,9,6,11],[12,1,12,12],[28,9,28,11],[18,14,18,16],[19,14,19,16],[24,1,24,17],[19,10,19,12],[13,1,19,1],[13,2,13,9],[15,4,15,9],[14,2,19,2],[16,10,16,12],[22,1,22,17],[20,1,20,17],[21,1,21,17],[18,4,18,9],[18,10,18,12],[19,4,19,9],[34,2,34,8],[34,10,34,12],[29,1,29,17],[30,1,30,17],[25,1,26,5],[25,6,26,8],[25,12,26,14],[25,15,26,17],[26,9,26,11],[27,1,27,5],[27,6,27,8],[27,9,27,11],[27,12,27,14],[27,15,27,17],[28,1,28,5],[28,6,28,8],[34,13,34,15],[28,12,28,14],[28,15,28,17],[39,1,39,6],[39,7,39,11],[39,12,39,17],[36,1,36,17],[37,1,37,6],[37,7,37,11],[37,12,37,17],[38,1,38,6],[38,7,38,11],[38,12,38,17],[32,1,32,17],[33,2,33,8],[33,10,33,12]]}
[]
[null,"（別紙様式１１－２ ）"]
[null,"在 宅 支 援 連 携 体 制 に 係 る 報 告 書\n〔　別添１の「第14の2」の１の（２）に規定する在宅療養支援診療所である場合に提出してください　〕"]
[null,"（ 令和6年8月1日現在 ）"]
[]
[null,null,null,null,null,null,null,null,null,"保険医療機関名",null,null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[null,null,null,null,null,null,null,null,null,"医療機関コード",null,null,{"$f":"IF(data!C1=\"\", \"\", data!C1)","v":""}]
[]
[null,"　当該報告書は、在宅支援連携体制を構築する複数の保険医療機関の実績を取りまとめて報告するものです。\n　なお、連携体制を構築する複数の保険医療機関のうち、１つの保険医療機関が代表して報告することとして差し支えありません。"]
[]
[null,"Ⅰ．直近１年間（令和5年8月1日～令和6年7月31日）に在宅療養を担当した患者について"]
[null,"１　平均診療期間",null,null,null,"※在宅医療を開始してからの診療期間を患者ごとに算出〔在宅医療の開始月と終了月をそれぞれ算入のこと。（期間が月を跨っている場合は2ヶ月と計算。）〕し、連携体制を構築する保険医療機関グループにおける平均診療期間を月単位で計上してください。",null,null,null,null,null,null,null,"(",null,null,null,"ヶ月　)"]
[null,"２　合計診療患者数",null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,"人　)"]
[null,null,"　【再掲】 死亡患者数",null,null,null,null,null,null,null,"①＋②＋③＋④",null,null,"(",{"$f":"IF(OR(O16=\"\",O17=\"\",O19=\"\",O20=\"\"),\"\",(O16+O17+O19+O20))","v":""},null,null,"人　)"]
[null,null,null," （１） うち医療機関以外での死亡者数",null,null,null,null,null,null,"①＋②",null,null,"(",{"$f":"IF(OR(O16=\"\",O17=\"\"),\"\",(O16+O17))","v":""},null,null,"人　)"]
[null,null,null,null,"　ア　うち自宅での死亡者数",null,null,null,null,null,"①",null,null,"(",null,null,null,"人　)"]
[null,null,null,null,"　イ　うち自宅以外での死亡者数",null,null,null,null,null,"②",null,null,"(",null,null,null,"人　)"]
[null,null,null," （２） うち医療機関での死亡者数",null,null,null,null,null,null,"③＋④",null,null,"(",{"$f":"IF(OR(O19=\"\",O20=\"\"),\"\",(O19+O20))","v":""},null,null,"人　)"]
[null,null,null,null,"　ア　うち連携医療機関での死亡者数",null,null,null,null,null,"③",null,null,"(",null,null,null,"人　)"]
[null,null,null,null,"　イ　うち連携医療機関以外での死亡者数",null,null,null,null,null,"④",null,null,"(",null,null,null,"人　)"]
[]
[null,"Ⅰの２（１）の「うち医療機関以外での死亡者数」を記入するに当たり、介護老人保健施設等の入所施設で死亡した患者については「イ　うち自宅以外での死亡者数」欄へ計上してください。"]
[null,"Ⅰの２（２）の「連携医療機関」とは、事前に緊急時の受入を届出ている医療機関であり、在宅支援連携体制についても含むものです。"]
[]
[null,"Ⅱ．直近１年間（令和5年8月1日～令和6年7月31日）の訪問診療等の実施回数について"]
[null,"訪問診療等の合計回数",null,null,null,null,"（１） 往診",null,null,null,null,null,"（２）訪問診療",null,null,"（３）訪問看護\n（緊急を含む）"]
[null,null,null,null,null,null,null,null,null,"【再掲】\nうち緊急の往診"]
[null,"　①＋②＋③",null,null,null,null,"　①",null,null,null,null,null,"　②",null,null,"　③"]
[null,{"$f":"IF(OR(G29<>\"\",M29<>\"\",P29<>\"\"),G29+M29+P29,\"\")","v":""}]
[]
[null,"Ⅱの「うち緊急の往診」については、緊急又は夜間・休日若しくは深夜に行った往診を計上してください。"]
[]
[null,"Ⅲ．在宅支援連携体制について"]
[null,1,"在宅医療を担当する常勤の医師数",null,null,null,null,null,null,"（",null,null,null,"人　）"]
[null,2,"連携する保険医療機関数",null,null,null,null,null,null,"(",null,null,null,"医療機関　）"]
[]
[null,"Ⅳ．在宅支援連携体制を構築している連携保険医療機関名　（上記Ⅰ・Ⅱ・Ⅲの数値計上の基礎となった保険医療機関）"]
[null,"",null,null,null,null,null,"",null,null,null,null,""]
[null,"",null,null,null,null,null,"",null,null,null,null,""]
[null,"",null,null,null,null,null,"",null,null,null,null,""]

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[]
[null,"（別紙様式１１－２）"]
[null,"在 宅 支 援 連 携 体 制 に 係 る 報 告 書\n〔　別添１の「第14の2」の１の（２）に規定する在宅療養支援病院である場合に提出してください　〕"]
[null,"（ 令和6年8月1日現在 ）"]
[]
[null,null,null,null,null,null,null,null,null,"保険医療機関名",null,null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[null,null,null,null,null,null,null,null,null,"医療機関コード",null,null,{"$f":"IF(data!C1=\"\", \"\", data!C1)","v":""}]
[]
[null,"　当該報告書は、在宅支援連携体制を構築する複数の保険医療機関の実績を取りまとめて報告するものです。\n　なお、連携体制を構築する複数の保険医療機関のうち、１つの保険医療機関が代表して報告することとして差し支えありません。"]
[]
[null,"Ⅰ．直近１年間（令和5年8月1日～令和6年7月31日）に在宅療養を担当した患者について"]
[null,"１　平均診療期間",null,null,null,"※在宅医療を開始してからの診療期間を患者ごとに算出〔在宅医療の開始月と終了月をそれぞれ算入のこと。（期間が月を跨っている場合は2ヶ月と計算。）〕し、連携体制を構築する保険医療機関グループにおける平均診療期間を月単位で計上してください。",null,null,null,null,null,null,null,"(",null,null,null,"ヶ月　)"]
[null,"２　合計診療患者数",null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,"人　)"]
[null,null,"　【再掲】 死亡患者数",null,null,null,null,null,null,null,"①＋②＋③＋④",null,null,"(",{"$f":"IFERROR(IF(OR(O16=\"\",O17=\"\",O19=\"\",O20=\"\"),\"\",(O16+O17+O19+O20)),\"\")","v":""},null,null,"人　)"]
[null,null,null," （１） うち医療機関以外での死亡者数",null,null,null,null,null,null,"①＋②",null,null,"(",{"$f":"IFERROR(IF(OR(O17=\"\",O17=\"\"),\"\",(O16+O17)),\"\")","v":""},null,null,"人　)"]
[null,null,null,null,"　ア　うち自宅での死亡者数",null,null,null,null,null,"①",null,null,"(",null,null,null,"人　)"]
[null,null,null,null,"　イ　うち自宅以外での死亡者数",null,null,null,null,null,"②",null,null,"(",null,null,null,"人　)"]
[null,null,null," （２） うち医療機関での死亡者数",null,null,null,null,null,null,"③＋④",null,null,"(",{"$f":"IFERROR(IF(OR(O19=\"\",O20=\"\"),\"\",(O19+O20)),\"\")","v":""},null,null,"人　)"]
[null,null,null,null,"　ア　うち連携医療機関での死亡者数",null,null,null,null,null,"③",null,null,"(",null,null,null,"人　)"]
[null,null,null,null,"　イ　うち連携医療機関以外での死亡者数",null,null,null,null,null,"④",null,null,"(",null,null,null,"人　)"]
[]
[null,"Ⅰの２（１）の「うち医療機関以外での死亡者数」を記入するに当たり、介護老人保健施設等の入所施設で死亡した患者については「イ　うち自宅以外での死亡者数」欄へ計上してください。"]
[null,"Ⅰの２（２）の「連携医療機関」とは、事前に緊急時の受入を届出ている医療機関であり、在宅支援連携体制についても含むものです。"]
[]
[null,"Ⅱ．直近１年間（令和5年8月1日～令和6年7月31日）の訪問診療等の実施回数について"]
[null,"訪問診療等の合計回数",null,null,null,null,"（１） 往診",null,null,null,null,null,"（２）訪問診療",null,null,"（３）訪問看護\n（緊急を含む）"]
[null,null,null,null,null,null,null,null,null,"【再掲】\nうち緊急の往診"]
[null,"　①＋②＋③",null,null,null,null,"　①",null,null,null,null,null,"　②",null,null,"　③"]
[null,{"$f":"IFERROR(IF(OR(G29<>\"\",M29<>\"\",P29<>\"\"),G29+M29+P29,\"\"),\"\")","v":""}]
[]
[null,"Ⅱの「うち緊急の往診」については、緊急又は夜間・休日若しくは深夜に行った往診を計上してください。"]
[]
[null,"Ⅲ．在宅支援連携体制について"]
[null,1,"在宅医療を担当する常勤の医師数",null,null,null,null,null,null,"（",null,null,null,"人　）"]
[null,2,"連携する保険医療機関数",null,null,null,null,null,null,"(",null,null,null,"医療機関　）"]
[]
[null,"Ⅳ．在宅支援連携体制を構築している連携保険医療機関名　（上記Ⅰ・Ⅱ・Ⅲの数値計上の基礎となった保険医療機関）"]
[null,"",null,null,null,null,null,"",null,null,null,null,""]
[null,"",null,null,null,null,null,"",null,null,null,null,""]
[null,"",null,null,null,null,null,"",null,null,null,null,""]

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["（別紙様式１２）"]
[]
["費用の計算の基礎となった項目ごとに記載した明細書の発行に関する報告書"]
[]
[null,null,null,null,null,null,null,null,null,"（令和６年８月１日現在）"]
[]
[null,null,null,null,null,null,null,"都道府県名",{"$f":"IF(data!B1=\"\",\"\",VLOOKUP(data!B1,list!A3:C49,3,FALSE))","v":""}]
[]
["医療機関コード\n※レセプトに記載する７桁の数字を記載すること。",{"$f":"IF(data!C1=\"\",\"\",data!C1)","v":""}]
["保険医療機関の名称",{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
["医科・歯科の別\n（該当するものを選択）",null,null,null,null,false,false]
["明細書を無料で\n交付していない患者\n（該当するものを選択）",null,"　　　　１．全ての患者",null,null,null,null,"   ２．公費負担医療に係る給付により自己負担がない患者   "]
["正当な理由\n（該当するものを選択）",null,"１．明細書発行機能が付与されていないレセプトコンピュータを使用している"]
[null,null,"２．自動入金機を使用しており、自動入金機での明細書発行を行うには、自動入金機の改修が必要"]
["レセプトコンピュータ\n又は\n自動入金機の改修時期","　改修予定年月を１に記載し、（）内のいずれかを選択すること。未定の場合は２に記載すること。"]
[null,"　１．令和",null,"年",null,"月"]
[null,"　２．令和",null,"年第",null,"四半期目途"]
["明細書の交付の際に\n徴収している金額",null,null,null,null,null,null,null,null,"円"]
[]
["※　本報告は、令和６年８月１日時点で保険医療機関及び保険医療養担当規則（昭和32年厚生省令第15号）に基づく"]
["　明細書の発行に係り「正当な理由」に該当する旨を届け出ている保険医療機関が提出すること。"]
["　　なお、上記の「正当な理由」について届出をしていない（明細書を無料で交付している）保険医療機関について"]
["　は、本報告の必要はない。"]

{"sheet":"別紙様式１４","index":22,"n_rows":39,"n_cols":13,"rows_kept":39,"cut":false,"hidden":false,"merged":[[13,1,14,7],[13,8,14,8],[13,9,14,11],[13,12,14,12],[2,1,2,12],[4,5,4,7],[4,8,4,12],[5,5,5,7],[5,8,5,12],[7,6,7,9],[7,11,7,12],[9,1,9,7],[9,8,10,8],[9,9,10,11],[9,12,10,12],[10,1,10,7],[15,1,16,7],[15,8,16,8],[15,9,16,11],[15,12,16,12],[17,1,18,7],[17,8,18,8],[17,9,18,11],[17,12,18,12],[21,4,21,5],[21,7,21,9],[24,4,24,5],[24,7,24,9],[27,4,27,5],[27,7,27,9],[36,1,36,12],[37,1,37,12],[38,1,38,12],[30,1,30,12],[31,1,31,12],[32,1,32,12],[33,1,33,12],[34,1,34,12],[35,1,35,12]]}
[null,"別紙様式１４"]
[]
[null,"糖尿病透析予防指導管理料に係る報告書"]
[]
[null,null,null,null,null,"保険医療機関名",null,null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[null,null,null,null,null,"医療機関コード",null,null,{"$f":"IF(data!C1=\"\", \"\", data!C1)","v":""}]
[]
[null,null,null,null,null,null,"報告年月日：令和６年８月",null,null,null,null,"日"]
[]
[null,"本指導管理料を算定した患者数",null,null,null,null,null,null,"①",null,null,null,"名"]
[null,"　（期間：令和５年４月～令和６年３月）"]
[]
[]
[null,"①のうち、当該期間後の７月末日までに HbA1c が改善又は維持された者",null,null,null,null,null,null,"②",null,null,null,"名"]
[]
[null,"①のうち、当該期間後の７月末日までに血中 Cre 又は eGFR が改善又は維持された者",null,null,null,null,null,null,"③",null,null,null,"名"]
[]
[null,"①のうち、当該期間後の７月末日までに血圧が改善又は維持された者",null,null,null,null,null,null,"④",null,null,null,"名"]
[]
[]
[null,"HbA1c が改善又は維持が認められた者の割合"]
[null,null,null,null,"＝　②／①",null,"⑤",{"$f":"IFERROR(IF(OR(J14=\"\",J10=\"\"),\"\",ROUND(J14/J10*100,0)),\"\")","v":""},null,null,"％"]
[]
[null,"Cre 又は eGFR が改善又は維持が認められた者の割合"]
[null,null,null,null,"＝　③／①",null,"⑥",{"$f":"IFERROR(IF(OR(J16=\"\",J10=\"\"),\"\",ROUND(J16/J10*100,0)),\"\")","v":""},null,null,"％"]
[]
[null,"血圧の改善又は維持が認められた者の割合"]
[null,null,null,null,"＝　④／①",null,"⑦",{"$f":"IFERROR(IF(OR(J18=\"\",J10=\"\"),\"\",ROUND(J18/J10*100,0)),\"\")","v":""},null,null,"％"]
[]
[null,"［記載上の注意点］"]
[null,"　　１　「①」の「本管理料を算定した患者数」は、糖尿病透析予防指導管理料"]
[null,"　　　を算定した患者数を計上すること。"]
[null,"　　２　「②」から「④」の「改善又は維持が認められた者」については、初回"]
[null,"　　　に糖尿病透析予防指導管理料を算定した日の直近の検査値と、報告時直近"]
[null,"　　　の検査値を比べること。"]
[null,"　　３　「①」における期間は、前年の４月１日から当年の３月３１日までとす"]
[null,"　　　る。ただし、新規に当該指導管理料の届出を行うなど、１年に満たない場"]
[null,"　　　合は、その届出日以降から当年の３月３１日までの期間の結果について記"]
[null,"　　　入すること。"]

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["（別紙様式１５）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（令和６年８月１日現在）"]
[]
["白内障に罹患している患者に対する水晶体再建に使用する眼鏡装用率の軽減効果を有する\n多焦点眼内レンズの支給に係る実施状況報告書"]
[]
[null,null,"都道府県名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(data!B1=\"\",\"\",VLOOKUP(data!B1,list!A3:C49,3,FALSE))","v":""}]
[]
[null,null,"医療機関コード",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(data!C1=\"\", \"\", data!C1)","v":""}]
[null,null,"※レセプトに記載する７桁の数字を記載すること。"]
[null,null,"保険医療機関名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[]
["多焦点眼内レンズの種類","販売名","医療機器承認番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"実施回数（※記載上の注意　４．を参照）",null,"患者からの徴収額（消費税を含む。）\n（※記載上の注意　５．を参照）"]
[null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回","",null,null,"円"]
[null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回","",null,null,"円"]
[null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回","",null,null,"円"]
[null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回","",null,null,"円"]
[null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回","",null,null,"円"]
[null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回","",null,null,"円"]
[null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回","",null,null,"円"]
[null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回","",null,null,"円"]
[null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回","",null,null,"円"]
[null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回","",null,null,"円"]
[]
["〔記載上の注意〕\n\n １．本報告については、前年８月１日～当年７月３１日の実施状況を記載すること。\n     なお、徴収した実績がない場合は報告の必要はない。\n \n ２．「多焦点眼内レンズの種類」については、多焦点後房レンズ、挿入器付後房レンズのうち、該当するものを記載すること。 \n\n ３．「医療機器承認番号」について、医薬品医療機器等法上の医療機器承認番号(16桁)を記載すること。\n\n ４．「実施回数」について、１人の患者に対して片眼に本療養を実施した場合を１回として計数する。\n　　同じ患者に対して両眼に本療養を実施した場合は２回として計数し、同一レンズについて、複数患者に対して本療養を実施した場合には、総実\n    施回数を記載すること。\n\n ５．「患者からの徴収額」は、眼鏡装用率の軽減効果を有する多焦点眼内レンズの支給に係る特別の料金（１眼当たり）として医療機関内に掲示\n　　した金額を記入すること。\n\n ６．眼鏡装用率の軽減効果を有する多焦点眼内レンズの支給に係る特別の料金に事前の報告と相違がある場合は、速やかに変更の報告を行うこ\n　　と。"]

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[]
["（別紙様式１６）"]
[]
["摂食嚥下機能回復体制加算に係る報告書"]
[]
[null,"都道府県名",null,null,null,null,null,{"$f":"IF(menu!B6=\"\", \"\", VLOOKUP(menu!B6,list!A3:C49,3,FALSE))","v":""}]
[null,"医療機関コード※",null,null,null,null,null,{"$f":"IF(menu!$D$6=\"\",\"\",TRIM(menu!$D$6))","v":""}]
[null,"保険医療機関名",null,null,null,null,null,{"$f":"IF(menu!I5=\"\",\"\",menu!I5)","v":""}]
[null,"※レセプトに記載する７桁の数字を記載すること"]
[]
[null,"摂食嚥下機能回復体制加算　　",null,null,null,null,null,null,false,"１・",false,"２・",false,3,"（該当するものに☑を付すること）"]
[]
[null,"１．嚥下機能の実績（加算１（⑨以外に記載）又は加算３（⑨に記載）に限る。加算２は記載不要。）"]
[null,"（１）実績期間\n"]
[null,null,"実績期間",null,null,null,"令和",null,null,"年",null,null,"月","～","令和",null,null,"年",null,null,"月"]
[null,null,"　備考："]
[null,"（２）摂食嚥下機能回復体制加算に係る経口摂取回復率"]
[null,"①","a.","１年間（１．の実績期間）に他の医療機関等から紹介された鼻腔栄養を実",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
[null,null,null,"施している患者、胃瘻を造設している患者、又は中心静脈を実施している患"]
[null,null,null,"者であって、当該医療機関において摂食機能療法を実施した者（転院、退院"]
[null,null,null,"した者を含む）"]
[null,null,"b.","１年間（１．の実績期間）に当該医療機関において鼻腔栄養を導入した患"]
[null,null,null,"者、胃瘻を造設した患者、又は中心静脈を開始した患者（転院、退院した"]
[null,null,null,"者を含む）"]
[null,null," 　ただし、a、bのいずれにおいても②から⑦までに該当する患者を除く。"]
[null,"②",null,"鼻腔栄養等を導入した日から起算して１年以内に死亡した患者（栄養方法が",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
[null,null,"　　経口摂取のみの状態に回復した患者を除く）"]
[null,"③",null,"鼻腔栄養等を導入した日から起算して１ヶ月以内に栄養方法が経口摂取のみ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
[null,null,"　　の状態に回復した患者"]
[null,"④",null,"①のaに該当する患者であって、当該医療機関に紹介された時点で、鼻腔",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
[null,null,"　　栄養等を導入した日から起算して１年以上が経過している患者"]
[null,"⑤",null,"消化器疾患等の患者であって、減圧ドレナージ目的で胃瘻造設を行った患者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
[]
[null,"⑥",null,"炎症性腸疾患の患者であって、成分栄養剤の経路として胃瘻造設が必要で",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
[null,null,"　　あった患者"]
[null,"⑦",null,"食道、胃噴門部の狭窄、食道穿孔等の食道や胃噴門部の疾患によって胃瘻",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
[null,null,"　　造設が必要であった患者"]
[null,"⑧",null,"摂食機能療法を開始した日から起算して１年以内に栄養方法が経口摂取のみ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
[null,null,"　　である状態へ回復した患者（ただし、②から⑦までに該当する患者を除く）"]
[null,null,"⑧",null,"／","①",null,null,"＝",{"$f":"IFERROR(IF(ROUND(W38/W18,1)*10=0,\"\",ROUND(W38/W18,1)*10),\"\")","v":""},null,"割"]
[]
[]
[null,"⑨",null,"中心静脈栄養を実施していた患者のうち、嚥下機能が回復し、中心静脈栄",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"",null,"人"]
[null,null,"　　養を終了した患者（加算３に限る）"]
[null,"[記載上の注意]"]
[null,"　１（１）は原則として報告時点の前年１月～12月の１年間の実績を記載することとし、それ以外の"]
[null,null,"期間とした場合には、その理由を備考に記載すること。"]
[null,null,"例）令和６年８月１日に当該加算に係る届出を行ったため、令和６年８月から令和６年12月の実績"]
[null,null,"を記載する事とした。"]
[null,"　２　②及び⑧の栄養方法が経口摂取のみである状態とは、内服薬又は水分を不定期に経口摂取以外"]
[null,null,"の方法で摂取する状態を含む。"]
[null,"　３　⑧の「栄養方法が経口摂取のみである状態」とは以下の状態をいう。"]
[null,null,"ア　鼻腔栄養を実施している患者にあっては、経鼻経管を抜去した上で、１か月以上"]
[null,null,"にわたって栄養方法が経口摂取のみであるもの。"]
[null,null,"イ　胃瘻を造設している患者にあっては、胃瘻抜去術又は胃瘻閉鎖術を実施した上で、１か月以上"]
[null,null,"にわたって栄養方法が経口摂取のみであるもの。"]
[null,null,"ウ　中心静脈栄養を実施している患者にあっては、中心静脈栄養を終了した上で、１か月以上"]
[null,null,"にわたって栄養方法が経口摂取のみであるもの。"]
[null,"　４　⑨については、摂食嚥下機能回復体制加算３に該当する場合のみ記載すること。"]
[null,null,"なお、該当していない場合は、「－」を記載すること。"]
[]
[null,"２．嚥下機能の評価"]
[null,"摂食嚥下機能回復体制加算１　"]
[null,"　届出の有無（",null,null,null,null,"有・",null,"無　）","（選択する。以下は有の場合のみ記載すること）"]
[null,"自院実施患者\n紹介患者の別\n（選択する）",null,null,null,"VF/VEの実施場所\n（選択する）",null,null,null,"患者\n性別","患者\n年齢","１の②~⑦のいずれかに該当するか※1",null,null,"FIM\n(開始時)\n(A)",null,"FIM\n(直近)\n(B)",null,"FOIS\n(開始時)\n(C)",null,"FOIS\n(直近)\n(D)",null,"日数\n※2"]
[]
[]
[]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[]
[null,"摂食嚥下機能回復体制加算２　"]
[null,"　届出の有無（",null,null,null,null,"有・",null,"無　）","（選択する。以下は有の場合のみ記載すること）"]
[null,"自院実施患者\n紹介患者の別\n（選択する）",null,null,null,"VF/VEの実施場所\n（選択する）",null,null,null,"患者\n性別","患者\n年齢","１の②~⑦のいずれかに該当するか※1",null,null,"FIM\n(開始時)\n(A)",null,"FIM\n(直近)\n(B)",null,"FOIS\n(開始時)\n(C)",null,"FOIS\n(直近)\n(D)",null,"日数\n※2"]
[]
[]
[]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[]
[null,"摂食嚥下機能回復体制加算３　"]
[null,"　届出の有無（",null,null,null,null,"有・",null,"無　）","（選択する。以下は有の場合のみ記載すること）"]
[null,"自院実施患者\n紹介患者の別\n（選択する）",null,null,null,"VF/VEの実施場所\n（選択する）",null,null,null,"患者\n性別","患者\n年齢","１の②~⑦のいずれかに該当するか※1",null,null,"FIM\n(開始時)\n(A)",null,"FIM\n(直近)\n(B)",null,"FOIS\n(開始時)\n(C)",null,"FOIS\n(直近)\n(D)",null,"日数\n※2"]
[]
[]
[]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"自院",null,"紹介",null,"自院",null,"紹介","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,"［記載上の注意］\n"]
[null,null,"１　②～⑦に該当する場合のみ該当する番号を記載すること（※１）。"]
[null,null,"２　日数は、摂食嚥下支援計画書の作成時の測定と、直近の測定までの期間を記載すること。な"]
[null,null,null,"お、FIMとFOISは同日に測定すること。従って（A）から（B）及び（C）から（D）までの"]
[null,null,null,"期間は、同じであること（※２）。"]
[null,null,"３　１．（１）に記入した期間の実績について記載すること。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"医療機関コード",null,null,null,{"$f":"IF($H$7=\"\",\"\",MID($H$7,1,1))","v":""},{"$f":"IF($H$7=\"\",\"\",MID($H$7,2,1))","v":""},{"$f":"IF($H$7=\"\",\"\",MID($H$7,3,1))","v":""},{"$f":"IF($H$7=\"\",\"\",MID($H$7,4,1))","v":""},{"$f":"IF($H$7=\"\",\"\",MID($H$7,5,1))","v":""},{"$f":"IF($H$7=\"\",\"\",MID($H$7,6,1))","v":""},{"$f":"IF($H$7=\"\",\"\",MID($H$7,7,1))","v":""}]

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["（別紙様式１７ー１）"]
["地域医療体制確保加算に係る報告書"]
["（令和６年８月１日）"]
[null,null,"都道府県名",{"$f":"IF(data!B1=\"\",\"\",VLOOKUP(data!B1,list!A3:C49,3,FALSE))","v":""}]
[null,null,"医療機関コード",{"$f":"IF(data!C1=\"\", \"\", data!C1)","v":""}]
[null,null,"※レセプトに記載する７桁の数字を記載すること。"]
[null,null,"保険医療機関名",{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[]
[null,"入院基本料又は特定入院料\n(プルダウン、または、「別表」から選択すること。)",null,"病棟（室）数",null,"病床数"]
[]
["１　当該加算の届出を行う病棟の種別及び病床数"]
[]
["※　現時点（令和６年８月１日）の情報を記載すること。"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"合計",null,"－",null,{"$f":"IF(COUNTA(F10:G24)=0,\"\",SUM(F10:G24))","v":""}]
["２　救急用の自動車等による搬送実績","期間：令和５年４月～６年３月"]
[null,"上記期間における救急用の自動車等による搬送件数："]
[null,"　　　　　　","（",null,null,"）件"]
["３　届出状況",false,"「Ａ２３７」ハイリスク分娩等管理加算\n（ハイリスク分娩管理加算に限る。）"]
[null,false,"「Ａ３０３」総合周産期特定集中治療室管理料"]
[null,false,"「Ａ３０１－４」小児特定集中治療室管理料"]
[null,false,"「Ａ３０２」新生児特定集中治療室管理料"]
["４　指定状況",false,"総合周産期母子医療センター"]
[null,false,"地域周産期母子医療センター"]
["５　病院勤務医の負担の軽減及び処遇の改善に資する体制","様式１７の２に記載すること。"]
[]
["〔記載上の注意〕"]
["　１  「１」については、「病棟（室）数」欄には入院基本料又は特定入院料の区分毎の病棟（室）数を、「病床数」欄には\n     同一区分の病棟（室）の病床数を合計した数を、「合計」欄には、全ての区分の病棟（室）の病床数を合計した数を、\n　　それぞれ記載すること。"]
["　２　「２」については、令和５年４月～６年３月の１年間の救急用の自動車等による搬送件数を記載すること。"]
["　３　様式１７の２を添付すること。"]

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[]
[null,"（別紙様式１７ー２）"]
[]
[null,"地域医療体制確保加算に係る報告書（病院勤務医の負担の軽減及び処遇の改善に資する体制について）"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"都道府県名",null,{"$f":"IF(data!B1=\"\",\"\",VLOOKUP(data!B1,list!A3:C49,3,FALSE))","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,"医療機関コード",null,{"$f":"IF(data!C1=\"\", \"\", data!C1)","v":""}]
[null,"届出時点の状況について記載する事項",null,null,null,null,null,null,null,null,null,null,"　※レセプトに記載する７桁の数字を記載すること。"]
[null,"　（□には、適合する場合「✓」を記入すること）",null,null,null,null,null,null,null,null,null,null,"保険医療機関名",null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[]
[null,"（１）　地域医療体制確保加算の算定状況"]
[null,null,"算定開始時点（",null,"",null,"）"]
[null,null,"備考※（　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　）","",null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,"※　算定開始後、当該加算を辞退した年月などがあれば具体的に記載すること。"]
[null,"（２）　病院勤務医の勤務時間及び当直を含めた夜間の勤務状況の把握"]
[null,null,"（令和６年８月１日時点）"]
[null,null,"ア　医療機関に勤務する医師数",null,null,null,null,null,"常勤：","（",null,null,"）名",null,"非常勤：","（",null,null,"）名"]
[null,null,null,null,null,null,null,null,"宿日直（＊１）を担当する医師数：（",null,null,null,null,null,"）名（うち非常勤（",null,null,null,"）名）"]
[null,null,null,null,null,null,null,null,null,null,"＊１ 宿日直については、平日の平均的な１日における体制を記載すること）"]
[null,null,"イ　病院勤務医の勤務状況の把握等（令和６年６月分）"]
[null,null,null,"(ア)　勤務時間の具体的な把握方法",null,null,null,null,null,false,"タイムカード、ＩＣカード、パソコンの使用時間"]
[null,null,null,null,null,null,null,null,null,false,"その他、客観的な記録方法"]
[null,null,null,null,null,null,null,null,null,null,"　　（具体的に：",null,"",null,null,null,null,null,null,"）"]
[null,null,null,"(イ)　勤務時間以外についての勤務状況（＊２）の把握内容の有無"]
[null,null,null,false,"年次有給休暇取得率",null,null,null,null,null,false,"時短勤務実施者（＊３）数"]
[null,null,null,false,"育児休業・介護休業の取得率",null,null,null,null,null,false,"その他"]
[null,null,null,null,null,null,null,null,null,null,null,"　（具体的に： ",null,"",null,null,null,null,null,"）"]
[null,null,null,null,null,"＊２  前年度の実績を記載。"]
[null,null,null,null,null,"＊３ 所定労働時間をあらかじめ減じた勤務体制としている者"]
[null,null,null,"（ウ） 超過勤務時間（時間／月）（＊４）"]
[null,null,null,null,"平均：","（",null,null,"）時間／月",null,null,"80時間／月以上の者の人数：",null,null,null,"（",null,null,"）名"]
[null,null,null,null,"最大：","（",null,null,"）時間／月",null,null,"155時間／月以上の者の人数：",null,null,null,"（",null,null,"）名"]
[null,null,null,null,"最小：","（",null,null,"）時間／月"]
[null,null,null,null,null,"＊４ 常勤医における値を記載。"]
[null,null,null,null,null,"＊４ 超過勤務時間： 法定休日以外の日において１日につき８時間を超えて労働した時間並びに１週について40時間を超えて労働した時間数\n"]
[null,null,null,null,null,"　　　及び法定休日（週に１日、又は、４週につき４日付与する義務あり）において労働した時間の総和"]
[null,null,null,"（エ） 宿日直（回／月）（＊５）",null,null,null,null,"平均：","（",null,null,"）回／月"]
[null,null,null,null,null,null,null,null,"最大：","（",null,null,"）回／月"]
[null,null,null,null,null,null,null,null,"最小：","（",null,null,"）回／月"]
[null,null,null,null,null,null,null,null,"連日当直を実施した者の人数及び回数：",null,null,null,null,"（",null,"）名　　・　　のべ（",null,null,"）回"]
[null,null,null,null,null,null,null,null,"＊５　労働基準法上の宿日直許可の取得に関わらず、休日及び時間外の当直、日直について回答してください。"]
[null,null,null,"（オ） その他（自由記載・補足等）"]
[null,null,null,""]
[]
[null,null,"ウ　令和５年度１年間における時間外・休日労働時間が一定時間を超える医師の人数について"]
[null,null,null,"1,785時間超",null,null,null,"（",null,"）名"]
[null,null,null,"1,710時間超",null,null,null,"（",null,"）名"]
[null,null,null,false,"医師の時間外・休日労働時間について基準を超える場合、理由及び改善のための計画を公開している。"]
[null,null,null,null,"※　特定地域医療提供医師又は連携型特定地域医療提供医師について、令和６年度において1,785時間、令和７年度に"]
[null,null,null,null,"　　 おいて1,710時間を超える時間外・休日労働時間を行った医師がいる場合、当該保険医療機関の見やすい場所及び"]
[null,null,null,"　"," 　　ホームページ等に掲示する等の方法で公開することとされている。"]
[]
[null,null,"（令和５年８月１日時点）"]
[null,null,"ア　医療機関に勤務する医師数",null,null,null,null,null,"常勤：","（",null,null,"）名",null,"非常勤：","（",null,null,"）名"]
[null,null,null,null,null,null,null,null,"宿日直（＊１）を担当する医師数：（",null,null,null,null,null,"）名（うち非常勤（",null,null,null,"）名）"]
[null,null,null,null,null,null,null,null,null,null,"＊１ 宿日直については、平日の平均的な１日における体制を記載すること）"]
[null,null,"イ　病院勤務医の勤務状況の把握等（令和５年６月分）"]
[null,null,null,"(ア)　勤務時間の具体的な把握方法",null,null,null,null,null,false,"タイムカード、ＩＣカード、パソコンの使用時間"]
[null,null,null,null,null,null,null,null,null,false,"その他、客観的な記録方法"]
[null,null,null,null,null,null,null,null,null,null,"　　（具体的に：",null,"",null,null,null,null,null,null,"）"]
[null,null,null,"(イ)　勤務時間以外についての勤務状況（＊２）の把握内容の有無"]
[null,null,null,false,"年次有給休暇取得率",null,null,null,null,null,false,"時短勤務実施者（＊３）数"]
[null,null,null,false,"育児休業・介護休業の取得率",null,null,null,null,null,false,"その他"]
[null,null,null,null,null,null,null,null,null,null,null,"　（具体的に： ",null,"",null,null,null,null,null,"）"]
[null,null,null,null,null,"＊２  前年度の実績を記載。"]
[null,null,null,null,null,"＊３ 所定労働時間をあらかじめ減じた勤務体制としている者"]
[null,null,null,"（ウ） 超過勤務時間（時間／月）（＊４）"]
[null,null,null,null,"平均：","（",null,null,"）時間／月",null,null,"80時間／月以上の者の人数：",null,null,null,"（",null,null,"）名"]
[null,null,null,null,"最大：","（",null,null,"）時間／月",null,null,"155時間／月以上の者の人数：",null,null,null,"（",null,null,"）名"]
[null,null,null,null,"最小：","（",null,null,"）時間／月"]
[null,null,null,null,null,"＊４ 常勤医における値を記載。"]
[null,null,null,null,null,"＊４ 超過勤務時間： 法定休日以外の日において１日につき８時間を超えて労働した時間並びに１週について40時間を超えて労働した時間数\n"]
[null,null,null,null,null,"　　　及び法定休日（週に１日、又は、４週につき４日付与する義務あり）において労働した時間の総和"]
[null,null,null,"（エ） 宿日直（回／月）（＊５）",null,null,null,null,"平均：","（",null,null,"）回／月"]
[null,null,null,null,null,null,null,null,"最大：","（",null,null,"）回／月"]
[null,null,null,null,null,null,null,null,"最小：","（",null,null,"）回／月"]
[null,null,null,null,null,null,null,null,"連日当直を実施した者の人数及び回数：",null,null,null,null,"（",null,"）名　　・　　のべ（",null,null,"）回"]
[null,null,null,null,null,null,null,null,"＊５　労働基準法上の宿日直許可の取得に関わらず、休日及び時間外の当直、日直について回答してください。"]
[null,null,null,"（オ） その他（自由記載・補足等）"]
[null,null,null,""]
[]
[null,null,"ウ　令和４年度１年間における時間外・休日労働時間が一定時間を超える医師の人数について"]
[null,null,null,"1,785時間超",null,null,null,"（",null,"）名"]
[null,null,null,"1,710時間超",null,null,null,"（",null,"）名"]
[null,null,null,false,"医師の時間外・休日労働時間について基準を超える場合、理由及び改善のための計画を公開している。"]
[null,null,null,null,"※　特定地域医療提供医師又は連携型特定地域医療提供医師について、令和６年度において1,785時間、令和７年度に"]
[null,null,null,null,"　　 おいて1,710時間を超える時間外・休日労働時間を行った医師がいる場合、当該保険医療機関の見やすい場所及び"]
[null,null,null,"　"," 　　ホームページ等に掲示する等の方法で公開することとされている。"]
[]
[null,null,"（令和４年８月１日時点）"]
[null,null,"ア　医療機関に勤務する医師数",null,null,null,null,null,"常勤：","（",null,null,"）名",null,"非常勤：","（",null,null,"）名"]
[null,null,null,null,null,null,null,null,"宿日直（＊１）を担当する医師数：（",null,null,null,null,null,"）名（うち非常勤（",null,null,null,"）名）"]
[null,null,null,null,null,null,null,null,null,null,"＊１ 宿日直については、平日の平均的な１日における体制を記載すること）"]
[null,null,"イ　病院勤務医の勤務状況の把握等（令和４年６月分）"]
[null,null,null,"(ア)　勤務時間の具体的な把握方法",null,null,null,null,null,false,"タイムカード、ＩＣカード、パソコンの使用時間"]
[null,null,null,null,null,null,null,null,null,false,"その他、客観的な記録方法"]
[null,null,null,null,null,null,null,null,null,null,"　　（具体的に：",null,"",null,null,null,null,null,null,"）"]
[null,null,null,"(イ)　勤務時間以外についての勤務状況（＊２）の把握内容の有無"]
[null,null,null,false,"年次有給休暇取得率",null,null,null,null,null,false,"時短勤務実施者（＊３）数"]
[null,null,null,false,"育児休業・介護休業の取得率",null,null,null,null,null,false,"その他"]
[null,null,null,null,null,null,null,null,null,null,null,"　（具体的に： ",null,"",null,null,null,null,null,"）"]
[null,null,null,null,null,"＊２  前年度の実績を記載。"]
[null,null,null,null,null,"＊３ 所定労働時間をあらかじめ減じた勤務体制としている者"]
[null,null,null,"（ウ） 超過勤務時間（時間／月）（＊４）"]
[null,null,null,null,"平均：","（",null,null,"）時間／月",null,null,"80時間／月以上の者の人数：",null,null,null,"（",null,null,"）名"]
[null,null,null,null,"最大：","（",null,null,"）時間／月",null,null,"155時間／月以上の者の人数：",null,null,null,"（",null,null,"）名"]
[null,null,null,null,"最小：","（",null,null,"）時間／月"]
[null,null,null,null,null,"＊４ 常勤医における値を記載。"]
[null,null,null,null,null,"＊４ 超過勤務時間： 法定休日以外の日において１日につき８時間を超えて労働した時間並びに１週について40時間を超えて労働した時間数\n"]
[null,null,null,null,null,"　　　及び法定休日（週に１日、又は、４週につき４日付与する義務あり）において労働した時間の総和"]
[null,null,null,"（エ） 宿日直（回／月）（＊５）",null,null,null,null,"平均：","（",null,null,"）回／月"]
[null,null,null,null,null,null,null,null,"最大：","（",null,null,"）回／月"]
[null,null,null,null,null,null,null,null,"最小：","（",null,null,"）回／月"]
[null,null,null,null,null,null,null,null,"連日当直を実施した者の人数及び回数：",null,null,null,null,"（",null,"）名　　・　　のべ（",null,null,"）回"]
[null,null,null,null,null,null,null,null,"＊５　労働基準法上の宿日直許可の取得に関わらず、休日及び時間外の当直、日直について回答してください。"]
[null,null,null,"（オ） その他（自由記載・補足等）"]
[null,null,null,""]
[]
[null,null,"ウ　令和３年度１年間における時間外・休日労働時間が一定時間を超える医師の人数について"]
[null,null,null,"1,785時間超",null,null,null,"（",null,"）名"]
[null,null,null,"1,710時間超",null,null,null,"（",null,"）名"]
[null,null,null,false,"医師の時間外・休日労働時間について基準を超える場合、理由及び改善のための計画を公開している。"]
[null,null,null,null,"※　特定地域医療提供医師又は連携型特定地域医療提供医師について、令和６年度において1,785時間、令和７年度に"]
[null,null,null,null,"　　 おいて1,710時間を超える時間外・休日労働時間を行った医師がいる場合、当該保険医療機関の見やすい場所及び"]
[null,null,null,"　"," 　　ホームページ等に掲示する等の方法で公開することとされている。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"医療機関コード",null,{"$f":"O8","v":""}]
[]
[null,"（３）　B水準・C水準等に相当する医師の働き方改革に向けた具体的な取組（実施している取組にチェック「✓」し、開始年月を回答）"]
[]
[null,null,"１　短時間勤務正規雇用医師の活用\n",null,null,null,null,null,null,null,false,"（","",null,"）"]
[null,null,"【要件】短時間勤務正規雇用医師を常勤医師20人につき１人以上雇用していること。"]
[null,null,"２　オンコール体制の構築\n",null,null,null,null,null,null,null,false,"（","",null,"）"]
[null,null,"【要件】医療機関全体で、医師60人(常勤換算)あたり１人以上オンコール医師がいること。"]
[null,null,"　　　　オンコール医師が所属する診療科の医師は、同じ日に宿日直をしていないこと。"]
[null,null,"３ 複数主治医制の実施\n",null,null,null,null,null,null,null,false,"（","",null,"）"]
[null,null,"【要件】当該医療機関の標榜診療科(外来診療のみの診療科を除く。)のうち半数以上で複数主治医制を導入していること。"]
[null,null,"４ 特定行為研修終了看護師の活用",null,null,null,null,null,null,null,false,"（","",null,"）"]
[null,null,"【要件】急性期医療に係る以下の各領域のすべてについて、それぞれ日勤帯には院内に常時特定行為研修終了者がおり、特定行為を行っていること。"]
[null,null,"・外科手術後管理領域"]
[null,null,"・術中麻酔管理領域"]
[null,null,"・外科系基本領域"]
[null,null,"・集中治療領域"]
[null,null,"・救急領域"]
[null,null,"５ 医師事務作業補助者の活用",null,null,null,null,null,null,null,false,"（","",null,"）"]
[null,null,"【要件】○対１の割合で医師事務作業補助者を配置していること。",null,null,null,null,null,null,null,null,"（",null,"対１）"]
[null,null,"６ 法令改正によりタスクシフトを可能とした業務の実施\n\n",null,null,null,null,null,null,null,false,"（","",null,"）"]
[null,null,"【要件】診療放射線技師、臨床検査技師、臨床工学技士、救急救命士の各職種について下に掲げる行為のうちそれぞれ半数(切り上げ)以上を行った場合。\nア　診療放射線技師\n・動脈路に造影剤注入装置を接続する行為（動脈路確保のためのものを除く。）、動脈に造影剤を投与するために当該造影剤注入装置を操作する行為\n・下部消化管検査（CTコロノグラフィ検査を含む。）のため、注入した造影剤及び空気を吸引する行為\n・上部消化管検査のために挿入した鼻腔カテーテルから造影剤を注入する行為、当該造影剤の投与が終了した後に鼻腔カテーテルを抜去する行為\n・医師又は歯科医師が診察した患者について、その医師又は歯科医師の指示を受け、病院又は診療所以外の場所に出張して行う超音波検査\n\nイ　臨床検査技師\n・直腸肛門機能検査（バルーン及びトランスデューサーの挿入（バルーンへの空気の注入を含む。）並びに抜去を含む。）\n・持続皮下グルコース検査（当該検査を行うための機器の装着及び脱着を含む。）\n・運動誘発電位検査・体性感覚誘発電位検査に係る電極（針電極を含む。）の装着及び脱着\n・検査のために、経口、経鼻又は気管カニューレ内部から喀痰を吸引して採取する行為\n・消化管内視鏡検査・治療において、医師の立会いの下、生検鉗子を用いて消化管から組織検体を採取する行為\n・静脈路を確保し、成分採血のための装置を接続する行為、成分採血装置を操作する行為、終了後に抜針及び止血する行為\n・超音波検査に関連する行為として、静脈路を確保して、造影剤を接続し、注入する行為、当該造影剤の投与が終了した後に抜針及び止血する行為\n\nウ　臨床工学技士\n・血液浄化装置の穿刺針その他の先端部の動脈表在化及び静脈への接続又は動脈表在化及び静脈からの除去\n・心血管カテーテル治療において、生命維持管理装置を使用して行う治療に関連する業務として、身体に電気的負荷を与えるために、当該負荷装置を操作する行為\n・手術室で行う鏡視下手術において、体内に挿入されている内視鏡用ビデオカメラを保持する行為、術野視野を確保するために内視鏡用ビデオカメラを操作する行為\n\nエ　救急救命士\n・医療機関に搬送されるまでの間（病院前）に重度傷病者に対して実施可能な救急救命処置について、救急外来※ においても実施可能とされた行為\n※救急外来とは、救急診療を要する傷病者が来院してから入院(病棟)に移行するまで(入院しない場合は、帰宅するまで)に必要な診察・検査・処置等を提供される場のことを指す。"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"医療機関コード",null,{"$f":"O8","v":""}]

{"sheet":"別紙様式１８","index":27,"n_rows":30,"n_cols":10,"rows_kept":30,"cut":false,"hidden":false,"merged":[[13,0,13,7],[0,0,0,9],[1,0,1,9],[2,0,2,9],[3,4,3,5],[3,6,3,8],[4,4,4,5],[4,6,4,8],[5,4,5,8],[6,4,6,5],[6,6,6,9],[9,6,9,8],[10,6,10,9],[14,0,14,7],[15,0,18,1],[18,2,18,7],[19,0,19,7],[20,0,20,2],[20,5,20,7],[27,0,27,9],[28,0,28,9],[29,0,29,9],[30,0,30,9],[21,5,21,8],[22,0,22,9],[23,0,23,9],[24,0,24,9],[25,0,25,9],[26,0,26,9]]}
["（別紙様式18）"]
["精神科救急・合併症入院料に関する実施状況報告書（８月報告）"]
["（令和６年８月１日）"]
[null,null,null,null,"都道府県名",null,{"$f":"IF(data!B1=\"\",\"\",VLOOKUP(data!B1,list!A3:C49,3,FALSE))","v":""}]
[null,null,null,null,"医療機関コード",null,{"$f":"IF(data!C1=\"\", \"\", data!C1)","v":""}]
[null,null,null,null,"※レセプトに記載する７桁の数字を記載すること。"]
[null,null,null,null,"保険医療機関名",null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[]
["１　病棟の体制に係る要件"]
["当該病院に常勤する精神保健指定医の人数",null,null,null,null,null,null,null,null,"名"]
["必要な検査及びＣＴ撮影が必要に応じて速やかに実施できる体制",null,null,null,null,null,""]
[]
["２　実績に係る要件"]
["①　当該病院の精神疾患にかかる時間外・休日・深夜の入院患者数",null,null,null,null,null,null,null,null,"人"]
["②　当該病棟の新規患者数",null,null,null,null,null,null,null,null,"人"]
["（②の再掲）",null,"③措置入院",null,null,"人","④緊急措置入院",null,null,"人"]
[null,null,"⑤医療保護入院",null,null,"人","⑥応急入院",null,null,"人"]
[null,null,"⑦鑑定入院",null,null,"人","⑧医療観察法入院",null,null,"人"]
[null,null,"⑨合併症ユニットへ入院する身体疾患を有する精神障害者\n　（③～⑧の患者を除く）",null,null,null,null,null,null,"人"]
["⑩　当該病院の所在する都道府県等における措置入院、緊急措置入院及び応急入院\n　　に係る新規入院患者数",null,null,null,null,null,null,null,null,"人"]
["(③＋④＋⑤＋⑥＋⑦＋⑧＋⑨)\n÷②",null,null,"(a)",{"$f":"IF(ISERROR((E16+I16+E17+I17+E18+I18+I19)/I15), \"\",ROUNDDOWN((E16+I16+E17+I17+E18+I18+I19)/I15,3)*100)","v":""},"(③＋④＋⑥)÷⑩",null,null,"(b)",{"$f":"IF(ISERROR((E16+I16+I17)/I20), \"\",ROUNDDOWN((E16+I16+I17)/I20,3)*100)","v":""}]
["⑪合併症ユニットに入院する身体合併症患者の割合",null,null,null,null,null,null,null,null,"%"]
["［記載上の注意］"]
["１　ＣＴ撮影につき他の保険医療機関との連携により速やかに実施できる体制が整備されている場合は、有にチェックをすること。"]
["２　実績に係る要件の患者数は報告前１年間の患者数を記載すること。"]
["３　当該病棟は次の要件を満たしていることが必要である。(a)≧60％　(b)≧25％又は、③＋④＋⑥≧５人"]
["４　⑩については、原則として当該病院の所在する都道府県における患者数を記載するものとするが、県内に複数の圏域がある場合は、"]
["当該圏域における患者数を記載すること。"]
["５　⑪の身体合併症患者とは、別添４「特定入院料の施設基準等」第16の2の1の(8)に掲げる疾患を有する患者であり、"]
["当該患者が合併症ユニットの80％以上であることが必要である。"]

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["（別紙様式19）"]
[null,null,null,null,null,null,null,null,null,"【都道府県名】　",null,{"$f":"IF(data!B1=\"\",\"\",VLOOKUP(data!B1,list!A3:C49,3,FALSE))","v":""}]
[null,null,null,null,null,null,null,null,null,"【医療機関コード】",null,{"$f":"IF(data!C1=\"\", \"\", data!C1)","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,"※レセプトに記載する７桁の数字を記載"]
[null,null,null,null,null,null,null,null,null,"【保険医療機関名】",null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[]
["精神科救急急性期医療入院料に関する実施状況報告書（令和６年８月１日現在）"]
[]
["１　病棟の体制に係る要件"]
["当該病院に常勤する精神保健指定医の人数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["必要な検査及びＣＴ撮影が必要に応じて速やかに実施できる体制",null,null,null,"","無"]
[null,null,null,null,null,"有（自保険医療機関内で速やかに実施可能）"]
[null,null,null,null,null,"有（CT検査については他の保険医療機関との連携により速やかに実施可能）"]
[]
["２　実績に係る要件"]
[]
["（１）　届出病棟数"]
["　以下の①～③の数値を記載し、括弧内の要件を満たす場合は、□に✓が記入されます。"]
["①　当該病院における精神科救急急性期医療入院料の届出病棟数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"病棟"]
["②　当該病院における精神科救急急性期医療入院料の届出病床数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"床"]
["③　当該病院における精神科救急急性期医療入院料及び精神科急性期治療病棟入院料届出病床数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"床"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(P21>300, NOT(ISNUMBER(P21))), FALSE, TRUE)","v":false},"(≦300）"]
["」"]
["（２）　精神科救急医療体制の整備等に係る実績"]
["　以下の④～⑬の数値を記載し、括弧内の要件を満たす場合は、該当する要件を選択すること。"]
[null,null,null,null,null,null,null,null,null,null,null,null,"当該病院における実績",null,null,null,"要件"]
["④　当該病院の精神疾患に係る時間外・休日・深夜の入院件数又は、当該圏域における人口1万人当たりの時間外・休日・深夜の入院件数",null,null,null,null,null,null,null,null,null,null,null,"④",null,"件"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"又は",null,null,"又は"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"件／万人"]
[null,"⑤　④のうち、精神科救急情報センター、精神医療相談窓口、救急医療情報センター、他の医療機関、都道府県（政令市の地域を含むものとする）、市町村、保健所、警察又は消防（救急車）からの依頼件数及び④に対する割合",null,null,null,null,null,null,null,null,null,null,"⑤",null,"件"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"又は",null,null,"又は"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"割"]
[null,"⑤の再掲",null,"⑥精神科救急情報センター",null,null,null,null,null,null,null,"件","⑦精神医療相談窓口",null,null,null,null,"件"]
[null,null,null,"⑧救急医療情報センター",null,null,null,null,null,null,null,"件","⑨他の医療機関",null,null,null,null,"件"]
[null,null,null,"⑩都道府県・市町村",null,null,null,null,null,null,null,"件","⑪保健所",null,null,null,null,"件"]
[null,null,null,"⑫警察",null,null,null,null,null,null,null,"件","⑬消防（救急車）",null,null,null,null,"件"]
[]
["（３）　当該病棟における新規入院患者に係る実績"]
["　以下の⑭～㉑について、報告前１年間の患者数を記載すること。"]
["【病棟１】"]
["⑭　当該入院料を算定する全病棟の新規患者数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
["⑮　措置入院",null,null,null,null,null,null,"人",null,"⑯　緊急措置入院",null,null,null,null,null,null,null,"人"]
["⑰　医療保護入院",null,null,null,null,null,null,"人",null,"⑱　応急入院",null,null,null,null,null,null,null,"人"]
[null,null,null,null,null,null,null,null,null,"（うち、特定医師によるもの）",null,null,null,null,null,null,null,"人"]
["⑲　鑑定入院",null,null,null,null,null,null,"人",null,"⑳　医療観察法入院",null,null,null,null,null,null,null,"人"]
["㉑　当該病院の所在する都道府県等における措置入院、緊急措置入院及び応急入院に係る新規入院患者数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
[]
["以下の「（a）」及び「（b）又は（c）」の数値を記載し、括弧内の要件を満たす場合は、□に✓が記入されます。"]
[null,null,null,null,null,null,null,null,null,null,"（⑮＋⑯＋⑱）÷㉑",null,null,null,"(b)",{"$f":"IF(ISERROR((F42+O42+O43)/J46),0, ROUNDDOWN((F42+O42+O43)/J46, 3)*100)","v":0}]
[]
["（⑮＋⑯＋⑰＋⑱＋⑲＋⑳）÷⑭",null,null,null,null,"(a)",{"$f":"IF(ISERROR((F42+O42+F43+O43+F45+O45)/J41),0,ROUNDDOWN((F42+O42+F43+O43+F45+O45)/J41, 3)*100)","v":0},null,null,null,null,null,null,null,null,{"$f":"IF(P49<25, FALSE, TRUE)","v":false},"（≧25％）"]
[null,null,null,null,null,null,null,null,null,"及び","又は"]
[null,null,null,null,null,null,{"$f":"IF(G51<60, FALSE, TRUE)","v":false},"（≧60％）",null,null,"（⑮＋⑯＋⑱）",null,null,null,"(c)",{"$f":"F42+O42+O43","v":0},null,"人"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(P53<20, FALSE, TRUE)","v":false},"（≧20人）"]
[]
["【病棟２】"]
["⑭　当該入院料を算定する全病棟の新規患者数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
["⑮　措置入院",null,null,null,null,null,null,"人",null,"⑯　緊急措置入院",null,null,null,null,null,null,null,"人"]
["⑰　医療保護入院",null,null,null,null,null,null,"人",null,"⑱　応急入院",null,null,null,null,null,null,null,"人"]
[null,null,null,null,null,null,null,null,null,"（うち、特定医師によるもの）",null,null,null,null,null,null,null,"人"]
["⑲　鑑定入院",null,null,null,null,null,null,"人",null,"⑳　医療観察法入院",null,null,null,null,null,null,null,"人"]
["㉑　当該病院の所在する都道府県等における措置入院、緊急措置入院及び応急入院に係る新規入院患者数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
[]
["以下の「（a）」及び「（b）又は（c）」の数値を記載し、括弧内の要件を満たす場合は、□に✓が記入されます。"]
[null,null,null,null,null,null,null,null,null,null,"（⑮＋⑯＋⑱）÷㉑",null,null,null,"(b)",{"$f":"IF(ISERROR((F59+O59+O60)/J63),0, ROUNDDOWN((F59+O59+O60)/J63, 3)*100)","v":0}]
[]
["（⑮＋⑯＋⑰＋⑱＋⑲＋⑳）÷⑭",null,null,null,null,"(a)",{"$f":"IF(ISERROR((F59+O59+F60+O60+F62+O62)/J58),0,ROUNDDOWN((F59+O59+F60+O60+F62+O62)/J58, 3)*100)","v":0},null,null,null,null,null,null,null,null,{"$f":"IF(P66<25, FALSE, TRUE)","v":false},"（≧25％）"]
[null,null,null,null,null,null,null,null,null,"及び","又は"]
[null,null,null,null,null,null,{"$f":"IF(G68<60, FALSE, TRUE)","v":false},"（≧60％）",null,null,"（⑮＋⑯＋⑱）",null,null,null,"(c)",{"$f":"F59+O59+O60","v":0},null,"人"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(P70<20, FALSE, TRUE)","v":false},"（≧20人）"]
[]
["【病棟３】"]
["⑭　当該入院料を算定する全病棟の新規患者数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
["⑮　措置入院",null,null,null,null,null,null,"人",null,"⑯　緊急措置入院",null,null,null,null,null,null,null,"人"]
["⑰　医療保護入院",null,null,null,null,null,null,"人",null,"⑱　応急入院",null,null,null,null,null,null,null,"人"]
[null,null,null,null,null,null,null,null,null,"（うち、特定医師によるもの）",null,null,null,null,null,null,null,"人"]
["⑲　鑑定入院",null,null,null,null,null,null,"人",null,"⑳　医療観察法入院",null,null,null,null,null,null,null,"人"]
["㉑　当該病院の所在する都道府県等における措置入院、緊急措置入院及び応急入院に係る新規入院患者数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
[]
["以下の「（a）」及び「（b）又は（c）」の数値を記載し、括弧内の要件を満たす場合は、□に✓が記入されます。"]
[null,null,null,null,null,null,null,null,null,null,"（⑮＋⑯＋⑱）÷㉑",null,null,null,"(b)",{"$f":"IF(ISERROR((F76+O76+O77)/J80),0, ROUNDDOWN((F76+O76+O77)/J80, 3)*100)","v":0}]
[]
["（⑮＋⑯＋⑰＋⑱＋⑲＋⑳）÷⑭",null,null,null,null,"(a)",{"$f":"IF(ISERROR((F76+O76+F77+O77+F79+O79)/J75),0,ROUNDDOWN((F76+O76+F77+O77+F79+O79)/J75, 3)*100)","v":0},null,null,null,null,null,null,null,null,{"$f":"IF(P83<25, FALSE, TRUE)","v":false},"（≧25％）"]
[null,null,null,null,null,null,null,null,null,"及び","又は"]
[null,null,null,null,null,null,{"$f":"IF(G85<60, FALSE, TRUE)","v":false},"（≧60％）",null,null,"（⑮＋⑯＋⑱）",null,null,null,"(c)",{"$f":"F76+O76+O77","v":0},null,"人"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(P87<20, FALSE, TRUE)","v":false},"（≧20人）"]
[]
["【病棟４】"]
["⑭　当該入院料を算定する全病棟の新規患者数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
["⑮　措置入院",null,null,null,null,null,null,"人",null,"⑯　緊急措置入院",null,null,null,null,null,null,null,"人"]
["⑰　医療保護入院",null,null,null,null,null,null,"人",null,"⑱　応急入院",null,null,null,null,null,null,null,"人"]
[null,null,null,null,null,null,null,null,null,"（うち、特定医師によるもの）",null,null,null,null,null,null,null,"人"]
["⑲　鑑定入院",null,null,null,null,null,null,"人",null,"⑳　医療観察法入院",null,null,null,null,null,null,null,"人"]
["㉑　当該病院の所在する都道府県等における措置入院、緊急措置入院及び応急入院に係る新規入院患者数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
[]
["以下の「（a）」及び「（b）又は（c）」の数値を記載し、括弧内の要件を満たす場合は、□に✓が記入されます。"]
[null,null,null,null,null,null,null,null,null,null,"（⑮＋⑯＋⑱）÷㉑",null,null,null,"(b)",{"$f":"IF(ISERROR((F93+O93+O94)/J97),0, ROUNDDOWN((F93+O93+O94)/J97, 3)*100)","v":0}]
[]
["（⑮＋⑯＋⑰＋⑱＋⑲＋⑳）÷⑭",null,null,null,null,"(a)",{"$f":"IF(ISERROR((F93+O93+F94+O94+F96+O96)/J92),0,ROUNDDOWN((F93+O93+F94+O94+F96+O96)/J92, 3)*100)","v":0},null,null,null,null,null,null,null,null,{"$f":"IF(P100<25, FALSE, TRUE)","v":false},"（≧25％）"]
[null,null,null,null,null,null,null,null,null,"及び","又は"]
[null,null,null,null,null,null,{"$f":"IF(G102<60, FALSE, TRUE)","v":false},"（≧60％）",null,null,"（⑮＋⑯＋⑱）",null,null,null,"(c)",{"$f":"F93+O93+O94","v":0},null,"人"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(P104<20, FALSE, TRUE)","v":false},"（≧20人）"]
[]
["【病棟５】"]
["⑭　当該入院料を算定する全病棟の新規患者数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
["⑮　措置入院",null,null,null,null,null,null,"人",null,"⑯　緊急措置入院",null,null,null,null,null,null,null,"人"]
["⑰　医療保護入院",null,null,null,null,null,null,"人",null,"⑱　応急入院",null,null,null,null,null,null,null,"人"]
[null,null,null,null,null,null,null,null,null,"（うち、特定医師によるもの）",null,null,null,null,null,null,null,"人"]
["⑲　鑑定入院",null,null,null,null,null,null,"人",null,"⑳　医療観察法入院",null,null,null,null,null,null,null,"人"]
["㉑　当該病院の所在する都道府県等における措置入院、緊急措置入院及び応急入院に係る新規入院患者数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
[]
["以下の「（a）」及び「（b）又は（c）」の数値を記載し、括弧内の要件を満たす場合は、□に✓が記入されます。"]
[null,null,null,null,null,null,null,null,null,null,"（⑮＋⑯＋⑱）÷㉑",null,null,null,"(b)",{"$f":"IF(ISERROR((F110+O110+O111)/J114),0, ROUNDDOWN((F110+O110+O111)/J114, 3)*100)","v":0}]
[]
["（⑮＋⑯＋⑰＋⑱＋⑲＋⑳）÷⑭",null,null,null,null,"(a)",{"$f":"IF(ISERROR((F110+O110+F111+O111+F113+O113)/J109),0,ROUNDDOWN((F110+O110+F111+O111+F113+O113)/J109, 3)*100)","v":0},null,null,null,null,null,null,null,null,{"$f":"IF(P117<25, FALSE, TRUE)","v":false},"（≧25％）"]
[null,null,null,null,null,null,null,null,null,"及び","又は"]
[null,null,null,null,null,null,{"$f":"IF(G119<60, FALSE, TRUE)","v":false},"（≧60％）",null,null,"（⑮＋⑯＋⑱）",null,null,null,"(c)",{"$f":"F110+O110+O111","v":0},null,"人"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(P121<20, FALSE, TRUE)","v":false},"（≧20人）"]
[]
[]
["［記載上の注意］"]
["１　ＣＴ撮影につき他の保険医療機関との連携により速やかに実施できる体制が整備されている場合は、「有（CT検査については他の"]
["　　保険医療機関との連携により速やかに実施可能）」にチェックをすること。"]
["２　「２の（１）の③」の病床数は300床以下であること。"]
["３　実績に係る要件の件数及び患者数は報告前１年間の数を記載すること。"]
["４　当該入院料を算定する病院は、以下のいずれも満たすこと。"]
[null,"・　「２の（２）の④」の件数が30件以上又は0.37件／万人以上"]
[null,"・　「２の（２）の⑤」の件数が６件以上又は「２の（２）の⑤」の割合が２割以上"]
["５　当該入院料を算定する病棟は、以下のいずれも満たすこと。"]
[null,"・　「２の（３）の(a)」の数値が６割以上"]
[null,"・　「２の（３）の(b)」の数値が２割５分以上又は「２の（３）の（c）」の人数が20人以上"]
["６　㉑については、原則として当該病院の所在する都道府県における患者数を記載するものとするが、"]
["県内に複数の圏域がある場合は、当該圏域における患者数を記載すること。"]
[]
[null,null,null,null,null,null,null,null,null,"【医療機関コード】",null,{"$f":"L3","v":""}]

{"sheet":"別紙様式２０","index":29,"n_rows":75,"n_cols":10,"rows_kept":75,"cut":false,"hidden":false,"merged":[[5,4,5,8],[6,4,6,5],[6,6,6,9],[9,0,9,1],[9,2,9,9],[10,0,10,1],[10,2,10,5],[10,6,10,9],[0,0,0,9],[1,0,1,9],[2,0,2,9],[3,4,3,5],[3,6,3,8],[4,4,4,5],[4,6,4,8],[14,0,14,1],[14,2,14,7],[14,8,14,9],[15,0,15,9],[16,0,16,7],[16,8,16,9],[11,0,11,1],[11,2,11,4],[11,6,11,8],[12,0,12,5],[12,6,12,7],[13,0,13,9],[22,0,22,1],[22,2,22,4],[22,6,22,8],[23,0,23,5],[23,6,23,7],[24,0,24,9],[17,0,17,5],[17,6,17,7],[20,0,20,1],[20,2,20,9],[21,0,21,1],[21,2,21,5],[21,6,21,9],[28,0,28,5],[28,6,28,7],[31,0,31,1],[31,2,31,9],[32,0,32,1],[32,2,32,5],[32,6,32,9],[25,0,25,1],[25,2,25,7],[25,8,25,9],[26,0,26,9],[27,0,27,7],[27,8,27,9],[36,0,36,1],[36,2,36,7],[36,8,36,9],[37,0,37,9],[38,0,38,7],[38,8,38,9],[33,0,33,1],[33,2,33,4],[33,6,33,8],[34,0,34,5],[34,6,34,7],[35,0,35,9],[44,0,44,1],[44,2,44,4],[44,6,44,8],[45,0,45,5],[45,6,45,7],[46,0,46,9],[39,0,39,5],[39,6,39,7],[42,0,42,1],[42,2,42,9],[43,0,43,1],[43,2,43,5],[43,6,43,9],[50,0,50,5],[50,6,50,7],[53,0,53,1],[53,2,53,9],[54,0,54,1],[54,2,54,5],[54,6,54,9],[47,0,47,1],[47,2,47,7],[47,8,47,9],[48,0,48,9],[49,0,49,7],[49,8,49,9],[58,0,58,1],[58,2,58,7],[58,8,58,9],[59,0,59,9],[60,0,60,7],[60,8,60,9],[55,0,55,1],[55,2,55,4],[55,6,55,8],[56,0,56,5],[56,6,56,7],[57,0,57,9],[67,0,67,9],[69,0,69,9],[70,2,70,9],[72,2,72,9],[74,0,74,9],[61,0,61,5],[61,6,61,7],[62,1,62,9],[63,0,63,9],[64,0,64,9],[65,0,65,9]]}
["（別紙様式20）"]
["精神科救急急性期医療入院料、精神科急性期治療病棟入院料及び\n精神科救急・合併症入院料の施設基準に係る報告書"]
["（令和６年８月１日）"]
[null,null,null,null,"都道府県名",null,{"$f":"IF(data!B1=\"\",\"\",VLOOKUP(data!B1,list!A3:C49,3,FALSE))","v":""}]
[null,null,null,null,"医療機関コード",null,{"$f":"IF(data!C1=\"\", \"\", data!C1)","v":""}]
[null,null,null,null,"※レセプトに記載する７桁の数字を記載すること。"]
[null,null,null,null,"保険医療機関名",null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[]
["【病棟１】"]
["該当する入院料を\n選択すること"]
[null,null,"新規患者（措置入院患者、鑑定入院患者及び医療観察法入院患者を含む）の延べ入院日数　②",null,null,null,"新規患者（措置入院患者、鑑定入院患者及び医療観察法入院患者を含む）以外の当該病棟患者の延べ入院日数　 ③"]
["①令和６年７月",null,null,null,null,"日",null,null,null,"日"]
["②／（②＋③）＝（ア）",null,null,null,null,null,{"$f":"IF(ISERROR(C12/(C12+G12)),\"\", ROUNDDOWN(C12/(C12+G12), 2))","v":""}]
["令和６年４月の延べ新規入院患者数（措置入院患者、鑑定入院患者、医療観察法入院患者及びクロザピンの新規導入を目的とした患者を除く）⑤"]
["④令和６年４月",null,null,null,null,null,null,null,"名"]
["⑥　上記の患者のうち、３月以内に退院し自宅等へ移行※した患者数"]
[null,null,null,null,null,null,null,null,"名"]
["⑥／⑤＝（イ）",null,null,null,null,null,{"$f":"IF(ISERROR(A17/C15),\"\", ROUNDDOWN(A17/C15, 2))","v":""}]
[]
["【病棟２】"]
["該当する入院料を\n選択すること"]
[null,null,"新規患者（措置入院患者、鑑定入院患者及び医療観察法入院患者を含む）の延べ入院日数　②",null,null,null,"新規患者（措置入院患者、鑑定入院患者及び医療観察法入院患者を含む）以外の当該病棟患者の延べ入院日数　 ③"]
["①令和６年７月",null,null,null,null,"日",null,null,null,"日"]
["②／（②＋③）＝（ア）",null,null,null,null,null,{"$f":"IF(ISERROR(C23/(C23+G23)),\"\", ROUNDDOWN(C23/(C23+G23), 2))","v":""}]
["令和６年４月の延べ新規入院患者数（措置入院患者、鑑定入院患者、医療観察法入院患者及びクロザピンの新規導入を目的とした患者を除く）⑤"]
["④令和６年４月",null,null,null,null,null,null,null,"名"]
["⑥　上記の患者のうち、３月以内に退院し自宅等へ移行※した患者数"]
[null,null,null,null,null,null,null,null,"名"]
["⑥／⑤＝（イ）",null,null,null,null,null,{"$f":"IF(ISERROR(A28/C26),\"\", ROUNDDOWN(A28/C26, 2))","v":""}]
[]
["【病棟３】"]
["該当する入院料を\n選択すること"]
[null,null,"新規患者（措置入院患者、鑑定入院患者及び医療観察法入院患者を含む）の延べ入院日数　②",null,null,null,"新規患者（措置入院患者、鑑定入院患者及び医療観察法入院患者を含む）以外の当該病棟患者の延べ入院日数　 ③"]
["①令和６年７月",null,null,null,null,"日",null,null,null,"日"]
["②／（②＋③）＝（ア）",null,null,null,null,null,{"$f":"IF(ISERROR(C34/(C34+G34)),\"\", ROUNDDOWN(C34/(C34+G34), 2))","v":""}]
["令和６年４月の延べ新規入院患者数（措置入院患者、鑑定入院患者、医療観察法入院患者及びクロザピンの新規導入を目的とした患者を除く）⑤"]
["④令和６年４月",null,null,null,null,null,null,null,"名"]
["⑥　上記の患者のうち、３月以内に退院し自宅等へ移行※した患者数"]
[null,null,null,null,null,null,null,null,"名"]
["⑥／⑤＝（イ）",null,null,null,null,null,{"$f":"IF(ISERROR(A39/C37),\"\", ROUNDDOWN(A39/C37, 2))","v":""}]
[]
["【病棟４】"]
["該当する入院料を\n選択すること"]
[null,null,"新規患者（措置入院患者、鑑定入院患者及び医療観察法入院患者を含む）の延べ入院日数　②",null,null,null,"新規患者（措置入院患者、鑑定入院患者及び医療観察法入院患者を含む）以外の当該病棟患者の延べ入院日数　 ③"]
["①令和６年７月",null,null,null,null,"日",null,null,null,"日"]
["②／（②＋③）＝（ア）",null,null,null,null,null,{"$f":"IF(ISERROR(C45/(C45+G45)),\"\", ROUNDDOWN(C45/(C45+G45), 2))","v":""}]
["令和６年４月の延べ新規入院患者数（措置入院患者、鑑定入院患者、医療観察法入院患者及びクロザピンの新規導入を目的とした患者を除く）⑤"]
["④令和６年４月",null,null,null,null,null,null,null,"名"]
["⑥　上記の患者のうち、３月以内に退院し自宅等へ移行※した患者数"]
[null,null,null,null,null,null,null,null,"名"]
["⑥／⑤＝（イ）",null,null,null,null,null,{"$f":"IF(ISERROR(A50/C48),\"\", ROUNDDOWN(A50/C48, 2))","v":""}]
[]
["【病棟５】"]
["該当する入院料を\n選択すること"]
[null,null,"新規患者（措置入院患者、鑑定入院患者及び医療観察法入院患者を含む）の延べ入院日数　②",null,null,null,"新規患者（措置入院患者、鑑定入院患者及び医療観察法入院患者を含む）以外の当該病棟患者の延べ入院日数　 ③"]
["①令和６年７月",null,null,null,null,"日",null,null,null,"日"]
["②／（②＋③）＝（ア）",null,null,null,null,null,{"$f":"IF(ISERROR(C56/(C56+G56)),\"\", ROUNDDOWN(C56/(C56+G56), 2))","v":""}]
["令和６年４月の延べ新規入院患者数（措置入院患者、鑑定入院患者、医療観察法入院患者及びクロザピンの新規導入を目的とした患者を除く）⑤"]
["④令和６年４月",null,null,null,null,null,null,null,"名"]
["⑥　上記の患者のうち、３月以内に退院し自宅等へ移行※した患者数"]
[null,null,null,null,null,null,null,null,"名"]
["⑥／⑤＝（イ）",null,null,null,null,null,{"$f":"IF(ISERROR(A61/C59),\"\", ROUNDDOWN(A61/C59, 2))","v":""}]
["※","自宅等へ移行とは、患家、介護老人保健施設、介護医療院又は精神障害者施設へ移行することをいう（ただし、死亡退院及び精神科急性期治療病棟入院料及び精神科救急・合併症入院料については退院後に医科点数表第１章第２部通則５の規定により入院期間が通算される再入院をした場合は除く。）。また、ここでいう「患家」とは、退院先のうち、同一の保険医療機関の当該入院料に係る病棟以外の病棟へ転棟した場合、他の保険医療機関へ転院した場合及び介護老人保健施設、介護医療院又は精神障害者施設に入所した場合を除いたものをいう。"]
["［記載上の注意］"]
["１　③には、当該病棟患者の延べ入院日数から②の延べ入院日数を引いた日数を記入する。"]
["２　⑤には、令和６年４月の延べ新規入院患者数（措置入院患者、鑑定入院患者、医療観察法入院患者及びクロザピンの新規導入を"]
["目的とした患者を除く。）を記入し、そのうち３月以内に退院し在宅へ移行した患者数を⑥に記入する。"]
["３　当該病棟は以下の条件を満たしていることが必要である。"]
[null,"（ア）≧ 0.4　"]
["４　当該病棟は以下の条件を満たしていることが必要である。"]
[null,"(1)","精神科救急・合併症入院料並びに精神科救急急性期医療入院料（精神科急性期医師配置加算１を算定する場合を除く）及び精神科急性期治療病棟入院料（精神科急性期医師配置加算１又は２のロを算定する場合を除く）"]
[null,null,"（イ）≧ 0.4"]
[null,"(2)","精神科救急急性期医療入院料（精神科急性期医師配置加算１を算定する場合）及び精神科急性期治療病棟入院料（精神科急性期医師配置加算１又は２のロを算定する場合）を算定する場合"]
[null,null,"（イ）≧ 0.6"]
["５　当該保険医療機関内に当該入院料を算定する病棟が複数ある場合は、病棟ごとに記載すること。"]

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["（別紙様式２１）"]
[]
["通院・在宅精神療法の注11（早期診療体制充実加算）に規定する施設基準に係る報告書"]
[]
[null,"都道府県名",null,null,null,{"$f":"IF(data!B1=\"\",\"\",VLOOKUP(data!B1,list!A3:C49,3,FALSE))","v":""}]
[null,"医療機関コード※",null,null,null,{"$f":"IF(data!C1=\"\",\"\",data!C1)","v":""},null,null,null,null,null,null,"　"]
[null,"保険医療機関名",null,null,null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[null,"※レセプトに記載する７桁の数字を記載すること"]
[]
["１　常勤の精神保健指定医の配置に係る要件"]
[null,"（常勤の精神保健指定医の氏名及び指定医番号を記入すること。）"]
[null,"氏名",null,null,null,null,null,"指定医番号"]
[null,null,null,null,null,null,null,""]
[null,null,null,null,null,null,null,""]
[null,null,null,null,null,null,null,""]
[null,null,null,null,null,null,null,""]
[null,null,null,null,null,null,null,""]
[]
["２　通院・在宅精神療法の算定回数に係る要件"]
[null,"（以下の各数値を記載し、要件を満たす場合は、□に✔が入力されます。）"]
[null,"当該保険医療機関が過去６か月間に実施した通院・在宅精神療法の算定回数",null,null,null,null,null,null,null,null,null,"回 (a) "]
[null,null,"うち","「１」のロ（初診の日に60分以上）",null,null,null,null,"の算定回数",null,null,"回 (b) "]
[null,null,null,"「１」のハの(１)（30分以上）",null,null,null,null,"の算定回数",null,null,"回 (c) "]
[null,null,null,"「２」のロ（初診の日に60分以上）",null,null,null,null,"の算定回数",null,null,"回 (d) "]
[null,null,null,"「２」のハの(１)（60分以上）",null,null,null,null,"の算定回数",null,null,"回 (e) "]
[null,null,null,"「２」のハの(２)（30分以上60分未満）",null,null,null,null,"の算定回数",null,null,"回 (f) "]
[null,null,"{(b)＋(c)＋(d)＋(e)＋(f)}／(a)",null,null,null,null,null,null,null,{"$f":"IFERROR(ROUNDDOWN(((K22+K23+K24+K25+K26)/K21)*100,1),\"\")","v":""},"（％）"]
[null,null,null,null,null,null,null,null,null,null,{"$f":"IF(K27=\"\",FALSE,IF(K27>=5,TRUE,FALSE))","v":false},"（≧５％）"]
[null,"※診療所にあっては、以下の各数値も記載し、要件を満たす場合は、□に✔が入力されます。"]
[null,"当該保険医療機関に勤務する精神科を担当する医師の数",null,null,null,null,null,null,null,null,null,"人 (g) ","　"]
[null,"{(b)＋(d)}／(g)",null,null,null,null,null,null,null,null,{"$f":"IFERROR(ROUNDDOWN((K22+K24)/K30,1),\"\")","v":""},"（回／人）"]
[null,null,null,null,null,null,null,null,null,null,{"$f":"IF(K31=\"\",FALSE,IF(K31>=60,TRUE,FALSE))","v":false},"（≧60）"]
[]
["３　精神保健指定医に係る要件（直近１年間の実績を記入すること）"]
[null,null,null,null,null,null,"指定医氏名①",null,null,"指定医氏名②"]
[null,null,null,null,null,null,"",null,null,""]
[null,null,null,null,null,null,"指定医番号",null,null,"指定医番号"]
[null,null,null,null,null,null,"",null,null,""]
["(１)","他医療機関で時間外、休日又は深夜における外来対応施設での外来診療又は救急医療機関で診療協力（外来、当直、対診等）を年６回以上行うこと（いずれも精神科医療を必要とする患者の診療を行うこと。）。"]
[null,null,null,null,null,null,"実施日","実施医療機関名",null,"実施日","実施医療機関名"]
[null,"実施日①（実施医療機関名）",null,null,null,null,"",null,null,""]
[null,"実施日②（実施医療機関名）",null,null,null,null,"",null,null,""]
[null,"実施日③（実施医療機関名）",null,null,null,null,"",null,null,""]
[null,"実施日④（実施医療機関名）",null,null,null,null,"",null,null,""]
[null,"実施日⑤（実施医療機関名）",null,null,null,null,"",null,null,""]
[null,"実施日⑥（実施医療機関名）",null,null,null,null,"",null,null,""]
["(２)","精神保健福祉法上の精神保健指定医として業務等（※）を年１回以上行っていること。（※）精神保健福祉法第十九条の四に規定する業務等を指す。"]
[null,"実施日（実施医療機関名）",null,null,null,null,"",null,null,""]
[null,null,"公務員としての業務の場合"]
[null,null,"①実施した業務の内容"]
[null,null,"②依頼元（都道府県名等）"]
[]
["４　当該保険医療機関の、地域の精神科救急医療体制の確保への協力に係る要件（直近１年間の実績を記入すること）"]
[]
["(１)","精神科救急医療体制整備事業で該当する施設を選択",null,null,null,"精神科救急医療確保事業において常時対応型施設として指定を受けている医療機関"]
[null,null,null,null,null,"身体合併症救急医療確保事業において指定を受けている医療機関"]
["(２)",false,"精神科救急医療確保事業において病院群輪番型施設として指定を受けている医療機関"]
[null,null,"①　当該保険医療機関の時間外、休日又は深夜における入院件数",null,null,null,null,null,null,null,null,"件（≧４件）"]
[null,null,null,"①のうち、精神科救急情報センター、精神医療相談窓口、救急医療情報センター、他の医療機関、都道府県（政令市の地域を含むものとする）、市町村、保健所、警察又は消防（救急車）からの依頼件数",null,null,null,null,null,null,null,"件（≧１件）"]
[null,null,"②　当該保険医療機関の時間外、休日又は深夜における外来対応件数",null,null,null,null,null,null,null,null,"件（≧10件）"]
[null,null,null,"②のうち、精神科救急情報センター、精神医療相談窓口、救急医療情報センター、他の医療機関、都道府県（政令市の地域を含むものとする）、市町村、保健所、警察又は消防（救急車）からの依頼件数（夜間、休日又は深夜以外の依頼件数も含む。）。",null,null,null,null,null,null,null,"件"]
["(３)","①",false,"精神科救急医療確保事業において外来対応施設として指定を受けている医療機関"]
[null,"②",false,"時間外対応加算１の届出を行っている。"]
[null,"③",false,"精神科救急情報センター、都道府県、市町村、保健所、警察、消防（救急車）、救命救急センター、一般医療機関等からの患者に関する問合せ等に対し、原則として当該保険医療機関において、常時対応できる体制がとられている。また、やむを得ない事由により、電話等による問合せに応じることができなかった場合であっても、速やかにコールバックすることができる体制がとられている。"]
[]
[null,null,null,null,null,null,null,null,"医療機関コード",{"$f":"F6","v":""}]
["５　早期診療体制充実加算における届出に係る要件"]
[null,"（届出を行っている場合は、□に✓を記入すること。）"]
[null,"児童思春期精神科専門管理加算",null,null,null,null,null,null,null,null,false]
[null,"療養生活継続支援加算",null,null,null,null,null,null,null,null,false]
[null,"児童思春期支援指導加算",null,null,null,null,null,null,null,null,false]
[null,"精神科リエゾンチーム加算",null,null,null,null,null,null,null,null,false]
[null,"依存症入院医療管理加算",null,null,null,null,null,null,null,null,false]
[null,"摂食障害入院医療管理加算",null,null,null,null,null,null,null,null,false]
[null,"精神科入退院支援加算",null,null,null,null,null,null,null,null,false]
[null,"児童・思春期精神科入院医療管理料",null,null,null,null,null,null,null,null,false]
[null,"認知療法・認知行動療法",null,null,null,null,null,null,null,null,false]
[null,"依存症集団療法１、２又は３",null,null,null,null,null,null,null,null,false]
[null,"精神科在宅患者支援管理料",null,null,null,null,null,null,null,null,false]
[]
["［記載上の注意］"]
["１","実績等については、照会に対し速やかに回答できるように医療機関で保管すること。"]
["２","「３」について、"]
[null,"・","当該保険医療機関に常勤の精神保健指定医が(２)を満たすこと。当該保険医療機関に常勤の精神保健指定医が２名以上勤務している場合は、少なくとも２名が(２)を満たすこと。"]
[null,"・","(２)について、当該精神保健指定医が以下の①から⑤に掲げる「公務員としての業務」を行っている場合は、実施した業務の内容及び当該業務を依頼した都道府県名又は政令指定都市名を記入すること。"]
[null,null,"①　措置入院及び緊急措置入院時の診察\n②　医療保護入院及び応急入院のための移送時の診察\n③　精神医療審査会における業務\n④　精神科病院への立入検査での診察\n⑤　その他都道府県の依頼による公務員としての業務"]
["３","「４」について、当該保険医療機関において、(１)、(２)又は(３)のいずれかの要件を満たすこと。具体的には、(２)の場合、精神科救急医療体制整備事業の病院群輪番型施設に該当し①又は②の要件を満たし、(３)の場合、①及び③又は②及び③の要件を満たすこと。"]
["４","「５」について、当該保険医療機関においていずれかを届け出ていること。"]
[]
[null,null,null,null,null,null,null,null,"医療機関コード",{"$f":"F6","v":""}]

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[]
["（別紙様式２２）"]
[]
["疾患別リハビリテーションに係る症例報告書"]
[]
[null,"都道府県名",null,null,null,null,null,{"$f":"IF(data!B1=\"\",\"\",VLOOKUP(data!B1,list!A3:C49,3,FALSE))","v":""}]
[null,"医療機関コード※",null,null,null,null,null,{"$f":"IF(data!C1=\"\", \"\", data!C1)","v":""}]
[null,"保険医療機関名",null,null,null,null,null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[null,"※レセプトに記載する７桁の数字を記載すること"]
[]
[null,"１．疾患別リハビリテーション料の算定状況について"]
[null,null,"　本年７月１日から3１日までの１ヶ月間に疾患別リハビリテーション料を算定した患者について実人数を記載すること。なお、同一の患者が複数回同一の傷病名により同一の疾患別リハビリテーション料を算定した場合は、１人として計算すること。"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"入院中の患者\n以外の患者",null,null,"入院中の患者"]
[null,null,"＜脳血管疾患等リハビリテーション料について＞"]
[null,null,"１）脳血管疾患等リハビリテーション料の算定患者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人",null,null,"人"]
[null,null,null,"２）　１）のうち、標準的算定日数（180日）を超えた患者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人",null,null,"人"]
[null,null,null,"※ ２）は３）と５）を足し合わせた数"]
[null,null,null,null," ３）　２）のうち、脳血管疾患等リハビリテーション料について、\n      治療を継続することにより状態の改善が期待できると医学的\n      に判断される、又は、治療上有効であると医学的に判断される\n      等の理由で、月13単位の算定上限の対象外となっている患者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人",null,null,"人"]
[]
[]
[null,null,null,null,null,"４）　３）のうち、要介護被保険者等",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人",null,null,"人"]
[null,null,null,null," ５）　２）のうち、月13単位の算定上限の対象となっている患者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人",null,null,"人"]
[]
[null,null,"＜廃用症候群リハビリテーション料について＞"]
[null,null,"１）廃用症候群リハビリテーション料の算定患者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人",null,null,"人"]
[null,null,null,"２）　１）のうち、標準的算定日数（120日）を超えた患者　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人",null,null,"人"]
[null,null,null,"※ ２）は３）と５）を足し合わせた数"]
[null,null,null,null," ３）　２）のうち、廃用症候群リハビリテーション料について、\n     治療を継続することにより状態の改善が期待できると医学的\n     に判断される、又は、治療上有効であると医学的に判断される\n     等の理由で、月13単位の算定上限の対象外となっている患者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人",null,null,"人"]
[]
[]
[null,null,null,null,null,"４）　３）のうち、要介護被保険者等",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人",null,null,"人"]
[null,null,null,null," ５）　２）のうち、月13単位の算定上限の対象となっている患者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人",null,null,"人"]
[]
[null,null,"＜運動器リハビリテーション料について＞"]
[null,null,"１）運動器リハビリテーション料の算定患者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人",null,null,"人"]
[null,null,null,"２）　１）のうち、標準的算定日数（150日）を超えた患者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人",null,null,"人"]
[null,null,null,"※ ２）は３）と５）を足し合わせた数"]
[null,null,null,null," ３）　２）のうち、運動器リハビリテーション料について、治療を\n       継続することにより状態の改善が期待できると医学的に判断\n       される、又は、治療上有効であると医学的に判断される等の\n       理由で、月13単位の算定上限の対象外となっている患者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人",null,null,"人"]
[]
[]
[null,null,null,null,null,"４）　３）のうち、要介護被保険者等",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人",null,null,"人"]
[null,null,null,null," ５）　２）のうち、月13単位の算定上限の対象となっている患者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人",null,null,"人"]
[]
[null,"２．患者の状態等について"]
[null,null,"　入院中の患者以外の患者について、本年７月１日から７日までの１週間の間に疾患別リハビリテーション料を算定した患者のうち「治療を継続することにより状態の改善が期待できると医学的に判断される、又は、治療上有効であると医学的に判断される等の理由で、月13単位の算定上限の対象外となっている患者」に該当している患者のデータ（入院中の患者以外の患者）を記載すること。"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,"１)年齢",null,null,"２）要介護度\n\n【選択肢】\n1.要支援１\n2.要支援２\n\n3.要介護１\n4.要介護２\n5.要介護３\n6.要介護４\n7.要介護５\n8.該当無し",null,null,"３）主な傷病\n※○は１つだけ",null,null,null,null,"４）上限日数となってからの期間\n※○は１つだけ",null,null,null,"５）ＡＤＬ",null,null,null,"６)単位\n数"]
[]
[]
[null,null,null,null,null,null,null,null,null,"【選択肢】\n1.脳血管疾患\n2.廃用症候群\n3.外傷\n4.外傷以外の整形外科疾患\n5.その他",null,null,null,null,"【選択肢】\n1.3か月未満\n2.3か月以上6か月未満\n3.6か月以上1年未満\n4.1年以上",null,null,null,"ＢＩ\n（Barthel Index）",null,"ＦＩＭ\n（126点満点でご記入ください）",null,"リハビリテーションの単位数（／週)"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"上限日数を超えた最初の診察日"," ８月１日時点","上限日数を超えた最初の診察日"," ８月１日時点"]
[]
[]
[]
[]
[]
[null,null,"例",75,null,"歳",6,null,null,2,null,null,null,null,3,null,null,null,30,60,40,50,7]
[]
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[null,null,35,null,null,"歳"]
[null,null,36,null,null,"歳"]
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[null,null,38,null,null,"歳"]
[null,null,39,null,null,"歳"]
[null,null,40,null,null,"歳"]
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[null,null,43,null,null,"歳"]
[null,null,44,null,null,"歳"]
[null,null,45,null,null,"歳"]
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[null,null,48,null,null,"歳"]
[null,null,49,null,null,"歳"]
[null,null,50,null,null,"歳"]
[]
[null,null,"[記載上の注意]\n１　１．については、入院していた患者が退院した等により、同一月内に「入院中以外の患者」及び「入院中の患者」の両方に当てはまる場合は、当該月内の初回の疾患別リハビリテーション料の算定により計算すること。\n\n２　２．5）の「上限日数を超えた最初の診察日」におけるBI（Bathel Index）及びFIMについて不明の場合は「－ 」と記入すること。"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"医療機関コード",null,null,null,{"$f":"H7","v":""}]

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["（別紙様式23）"]
["情報通信機器を用いた診療に係る報告書（８月報告）"]
["（令和６年８月１日）"]
[null,null,null,null,"保険医療機関名",{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[null,null,null,null,"医療機関コード",{"$f":"IF(data!C1=\"\",\"\",data!C1)","v":""}]
[null,null,null,null,"※レセプトに記載する７桁の数字を記載すること。"]
[null,null,null,null,"郵便番号",""]
[null,null,null,null,"所在地",""]
[]
["１　情報通信機器を用いた診療実施状況"]
["１）患者の所在が、上記医療機関と同一の市町村又は特別区である場合"]
[null,null,null,null,"診療件数",null,"そのうち「自身では対応困難な疾患・病態の患者や緊急性がある場合」として、他の医療機関へ紹介を実施したものの件数"]
["患者の所在が、上記医療機関と同一の市町村又は特別区である場合（①）",null,null,null,null,"件",null,null,null,null,null,"件"]
["患者の所在が、上記医療機関と異なる市町村又は特別区である場合（②）",null,null,null,null,"件",null,null,null,null,null,"件"]
["全診療件数のうち、患者の所在が、上記医療機関と異なる市町村又は特別区である場合の割合（②／①＋②）",null,null,null,{"$f":"IF(ISERROR(E14/SUM(E13:E14)),\"\",ROUNDDOWN(E14/SUM(E13:E14)*100, 1))","v":""},"％"]
[]
["２）患者の所在が、上記医療機関と異なる市町村又は特別区である場合の直接の対面診療を行える体制の整備状況（具体的な医療機関名、紹介・連絡・情報提供の方法、事前合意の有無など）"]
["市町村又は特別区名",null,null,"直接の対面診療を行える体制の整備状況"]
["",null,null,""]
["",null,null,""]
["",null,null,""]
["",null,null,""]
["",null,null,""]
["",null,null,""]
["",null,null,""]
["",null,null,""]
["",null,null,""]
["",null,null,""]
[]
["３）医師が上記医療機関外で情報通信機器を用いた診療を実施した場合"]
["医師名","常勤／\n非常勤",null,"オンライン診療を実施した場所",null,null,"都道府県","診療録等、過去の患者の状態を把握する体制"]
["",null,null,false,null,null,"",false]
[null,null,null,false,null,null,null,false]
[null,null,null,false,null,null,null,""]
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["",null,null,false,null,null,"",false]
[null,null,null,false,null,null,null,false]
[null,null,null,false,null,null,null,""]
[null,null,null,""]
["",null,null,false,null,null,"",false]
[null,null,null,false,null,null,null,false]
[null,null,null,false,null,null,null,""]
[null,null,null,""]
["",null,null,false,null,null,"",false]
[null,null,null,false,null,null,null,false]
[null,null,null,false,null,null,null,""]
[null,null,null,""]
["",null,null,false,null,null,"",false]
[null,null,null,false,null,null,null,false]
[null,null,null,false,null,null,null,""]
[null,null,null,""]
["",null,null,false,null,null,"",false]
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["",null,null,false,null,null,"",false]
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[null,null,null,"テスト"]
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[]
["２　情報通信機器を用いた診療の件数"]
[null,null,"対面診療で実施した診療の算定件数",null,null,null,"情報通信機器を用いた診療の算定件数"]
[null,null,"初診料",null,"再診料等\n（外来診療料を含む）",null,"初診料\n（初診料を算定した患者の内、診療前相談を行った件数）\n（初診料を算定した患者の内、その後自院にて対面診療を行わなかった件数）",null,null,"再診料等\n（外来診療料を含む）"]
["８月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、診療前相談を行った件数",null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、その後自院にて対面診療を行わなかった件数",null,"件"]
["９月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、診療前相談を行った件数",null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、その後自院にて対面診療を行わなかった件数",null,"件"]
["１０月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、診療前相談を行った件数",null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、その後自院にて対面診療を行わなかった件数",null,"件"]
["１１月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、診療前相談を行った件数",null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、その後自院にて対面診療を行わなかった件数",null,"件"]
["１２月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、診療前相談を行った件数",null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、その後自院にて対面診療を行わなかった件数",null,"件"]
["１月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、診療前相談を行った件数",null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、その後自院にて対面診療を行わなかった件数",null,"件"]
["２月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、診療前相談を行った件数",null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、その後自院にて対面診療を行わなかった件数",null,"件"]
["３月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、診療前相談を行った件数",null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、その後自院にて対面診療を行わなかった件数",null,"件"]
["４月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、診療前相談を行った件数",null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、その後自院にて対面診療を行わなかった件数",null,"件"]
["５月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、診療前相談を行った件数",null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、その後自院にて対面診療を行わなかった件数",null,"件"]
["６月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、診療前相談を行った件数",null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、その後自院にて対面診療を行わなかった件数",null,"件"]
["７月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、診療前相談を行った件数",null,"件"]
[null,null,null,null,null,null,"初診料を算定した患者の内、その後自院にて対面診療を行わなかった件数",null,"件"]
[]
["３　診療前相談の実施状況（複数回答可）"]
[false]
[false]
[false]
[""]
["〔記載上の注意〕"]
["１　本報告については、前年８月１日あるいは「情報通信機器を用いた診療」に係る届出を行って以後～当年７月３１日の診療実施状況を記載すること。\n　なお、診療した実績がない場合は報告の必要はない。 \n２　「１　２）患者の所在が、上記医療機関と異なる市町村又は特別区である場合の直接の対面診療を行える体制の整備状況」については、全診療件数のうち、患者の所在が、上記医療機関と異なる市町村又は特別区である場合の割合が２割を超える場合に記載すること。なお、市町村及び特別区については診療件数の多い10箇所 について記載すること。\n３　「１　３）医師が上記医療機関外で情報通信機器を用いた診療を実施した場合」については、該当する全ての医師について記載すること。なお、医師が５名を超える場合は適宜行を追加して記載すること。\n４　「２　情報通信機器を用いた診療の件数」のうち「対面診療で実施した診療の算定件数」については、情報通信機器を用いた診療を実施していない患者を含む全ての患者を対象として報告して下さい。"]

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["（別紙様式24）"]
[null,null,null,null,null,null,null,null,null,"【都道府県名】　",null,{"$f":"IF(data!B1=\"\",\"\",VLOOKUP(data!B1,list!A3:C49,3,FALSE))","v":""}]
[null,null,null,null,null,null,null,null,null,"【医療機関コード】",null,{"$f":"IF(data!C1=\"\", \"\", data!C1)","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,"※レセプトに記載する７桁の数字を記載"]
[null,null,null,null,null,null,null,null,null,"【保険医療機関名】",null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[]
["精神科救急医療体制加算に関する実施状況報告書（令和６年８月１日現在）"]
[]
["１　病棟の体制に係る要件"]
["当該病院に常勤する精神保健指定医の人数",null,null,null,null,null,1,null,null,null,null,null,null,null,null,null,"名"]
[]
["２　実績に係る要件"]
["（１）　届出病棟数"]
["病棟数",null,null,null,null,null,null,null,"病床数（合計）"]
[null,null,null,null,null,null,"病棟",null,null,null,null,null,null,"床"]
[]
["３　精神科救急医療体制の整備等に係る実績"]
["　以下の①～⑩の数値を記載し、要件を満たす場合は、要件を選択すること。"]
[null,null,null,null,null,null,null,null,null,"当該病院における実績",null,null,"複数の病棟を\n届け出る場合",null,null,null,"要件を満たす場合、選択"]
["①","当該病院の精神疾患に係る時間外・休日・深夜の入院件数又は当該圏域における人口1万人当たりの時間外・休日・深夜の入院件数",null,null,null,null,null,null,null,"①",null,null,"①÷届出病棟数"]
[null,null,null,null,null,null,null,null,null,null,"件",null,null,null,"件"]
[null,null,null,null,null,null,null,null,null,"又は",null,null,"又は",null,null,null,"又は"]
[null,null,null,null,null,null,null,null,null,null,"件／万人",null,null,null,"件／万人"]
["②","①のうち、精神科救急情報センター、精神医療相談窓口、救急医療情報センター、他の医療機関、都道府県（政令市の地域を含むものとする）、市町村、保健所、警察又は消防（救急車）からの依頼件数及び①に対する割合",null,null,null,null,null,null,null,"②",null,null,"②÷届出病棟数"]
[null,null,null,null,null,null,null,null,null,null,"件",null,null,null,"件"]
[null,null,null,null,null,null,null,null,null,"又は",null,null,null,null,null,null,"又は"]
[null,null,null,null,null,null,null,null,null,null,"割"]
["②の再掲","➂精神科救急情報センター",null,null,null,null,null,null,"件","④精神医療相談窓口",null,null,null,null,null,null,null,"件"]
[null,"⑤救急医療情報センター",null,null,null,null,null,null,"件","⑥他の医療機関",null,null,null,null,null,null,null,"件"]
[null,"⑦都道府県・市町村",null,null,null,null,null,null,"件","⑧保健所",null,null,null,null,null,null,null,"件"]
[null,"⑨警察",null,null,null,null,null,null,"件","⑩消防（救急車）",null,null,null,null,null,null,null,"件"]
[]
["４　当該病棟における新規入院患者の自宅等への移行について"]
[false,"当該病棟において新規入院患者（措置入院患者、鑑定入院患者、医療観察法入院患者及びクロザピンの新規導入を目的とした入院患者を除く。）のうち、６割以上が入院日から起算して３月以内に、退院し、自宅等へ移行していること。"]
["　※満たしている場合に、□に✓を記入すること"]
[]
["５　施設類型に係る事項"]
["　次の該当する項目のいずれかを選択すること。"]
[null,"「精神科救急医療体制整備事業実施要綱」（平成20年５月26日障発0526001号厚生労働省社会・援護局障害保健福祉部長）（以下「精神科救急医療体制整備事業実施要綱」という。）に規定する身体合併症救急医療確保事業において指定を受けている医療機関"]
[null,"「精神科救急医療体制整備事業実施要綱」に規定する精神科救急医療確保事業において常時対応型施設として指定を受けている医療機関"]
[null,"「精神科救急医療体制整備事業実施要綱」に規定する精神科救急医療確保事業において病院群輪番型施設として指定を受けている医療機関"]
[]
["［記載上の注意］"]
["１　当該病院に常勤する精神保健指定医は５名以上であること。"]
["２　実績に係る要件の患者数は報告前１年間の患者数を記載すること。"]
["３　「４」の「自宅等へ移行」とは、患家、介護老人保健施設、介護医療院又は精神障害者施設へ移行することである。"]

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["（別紙様式25）"]
["情報通信機器を用いた精神療法に係る報告書（８月報告）"]
[null,null,null,null,null,null,null,null,null,null,null,"（令和６年８月１日）"]
[null,"保険医療機関名",null,null,null,null,null,null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[null,"保険医療機関コード（レセプトに記載する７桁の数字を記載）",null,null,null,null,null,null,{"$f":"IF(data!C1=\"\",\"\",data!C1)","v":""}]
[null,"郵便番号",null,null,null,null,null,null,""]
[null,"所在地",null,null,null,null,null,null,""]
[]
["１　情報通信機器を用いた精神療法を実施する精神保健指定医に係る要件"]
[null,null,null,null,null,null,"指定医氏名①",null,null,null,null,"指定医氏名②"]
[null,null,null,null,null,null,"",null,null,null,null,""]
[null,null,null,null,null,null,"指定医番号",null,null,null,null,"指定医番号"]
[null,null,null,null,null,null,"",null,null,null,null,""]
["（１）","他医療機関で時間外、休日又は深夜における外来対応施設での外来診療又は救急医療機関で診療協力（外来、当直、対診等）を年６回以上行うこと（いずれも精神科医療を必要とする患者の診療を行うこと。）。"]
[null,null,null,null,null,null,"実施日",null,"実施医療機関名",null,null,"実施日",null,"実施医療機関名"]
[null,"実施日①（実施医療機関名）",null,null,null,null,"",null,"",null,null,"",null,""]
[null,"実施日②（実施医療機関名）",null,null,null,null,"",null,"",null,null,"",null,""]
[null,"実施日③（実施医療機関名）",null,null,null,null,"",null,"",null,null,"",null,""]
[null,"実施日④（実施医療機関名）",null,null,null,null,"",null,"",null,null,"",null,""]
[null,"実施日⑤（実施医療機関名）",null,null,null,null,"",null,"",null,null,"",null,""]
[null,"実施日⑥（実施医療機関名）",null,null,null,null,"",null,"",null,null,"",null,""]
["（２）","精神保健福祉法上の精神保健指定医として業務等（※）を年１回以上行っていること。（※）精神保健福祉法第十九条の四に規定する業務等を指す。"]
[null,"実施日（実施医療機関名）",null,null,null,null,"",null,"",null,null,"",null,""]
[null,null,"公務員としての業務の場合"]
[null,null,"①実施した業務の内容",null,null,null,"",null,null,null,null,""]
[null,null,"②依頼元（都道府県名等）",null,null,null,"",null,null,null,null,""]
[]
["２　情報通信機器を用いた精神療法の実施状況"]
["（１）","患者の所在毎の情報通信機器を用いた精神療法の実施状況"]
[null,null,null,"実施件数",null,"そのうち、「患者の急変や自殺未遂等の緊急時又は向精神薬等の乱用や依存の傾向が認められる場合等」、対面診療が必要と判断された件数"]
[null,null,null,null,null,null,null,"情報通信機器を用いた精神療法を実施した医師自らが速やかに対面診療を実施した件数",null,null,"当該保険医療機関において、情報通信機器を用いた精神療法を実施した医師以外の医師が対面診療を実施した件数",null,null,"患者が速やかに受診できる医療機関に紹介した件数"]
[null,"患者の所在が、上記医療機関と同一の市町村又は特別区である場合（①）",null,null,"件",null,"件",null,null,"件",null,null,"件",null,null,"件"]
[null,"患者の所在が、上記医療機関と異なる市町村又は特別区である場合（②）",null,null,"件",null,"件",null,null,"件",null,null,"件",null,null,"件"]
[null,"全診療件数のうち、患者の所在が、上記医療機関と異なる市町村又は特別区である場合の割合\n（②/(①＋②)）",null,{"$f":"IF(ISERROR(D33/SUM(D32:D33)),\"\",ROUNDDOWN(D33/SUM(D32:D33)*100, 1))","v":""},"％",{"$f":"IF(ISERROR(F33/SUM(F32:F33)),\"\",ROUNDDOWN(F33/SUM(F32:F33)*100, 1))","v":""},"％",{"$f":"IF(ISERROR(H33/SUM(H32:H33)),\"\",ROUNDDOWN(H33/SUM(H32:H33)*100, 1))","v":""},null,"％",{"$f":"IF(ISERROR(K33/SUM(K32:K33)),\"\",ROUNDDOWN(K33/SUM(K32:K33)*100, 1))","v":""},null,"％",{"$f":"IF(ISERROR(N33/SUM(N32:N33)),\"\",ROUNDDOWN(N33/SUM(N32:N33)*100, 1))","v":""},null,"％"]
[]
["（２）","患者の所在が、上記医療機関と異なる市町村又は特別区である場合の直接の対面診療を行える体制の整備状況（具体的な医療機関名、紹介・連絡・情報提供の方法、事前合意の有無など）"]
[null,"市町村又は特別区名",null,null,null,null,null,"直接の対面診療を行える体制の整備状況"]
[null,"",null,null,null,null,null,""]
[null,"",null,null,null,null,null,""]
[null,"",null,null,null,null,null,""]
[null,"",null,null,null,null,null,""]
[null,"",null,null,null,null,null,""]
[null,"",null,null,null,null,null,""]
[null,"",null,null,null,null,null,""]
[null,"",null,null,null,null,null,""]
[null,"",null,null,null,null,null,""]
[null,"",null,null,null,null,null,""]
[null,"",null,null,null,null,null,""]
[]
[null,null,null,null,null,null,null,null,"保険医療機関コード",null,null,{"$f":"I5","v":""}]
["（３）","情報通信機器を用いた精神療法を行った患者に対して処方した抗不安薬、睡眠薬、抗うつ薬又は抗精神病薬の種類数"]
[null,"種類数",null,null,"抗不安薬",null,null,"睡眠薬",null,null,"抗うつ薬",null,null,"抗精神病薬"]
[null,"０種類",null,null,null,null,"件",null,null,"件",null,null,"件",null,null,"件"]
[null,"１種類",null,null,null,null,"件",null,null,"件",null,null,"件",null,null,"件"]
[null,"２種類",null,null,null,null,"件",null,null,"件",null,null,"件",null,null,"件"]
[null,"３種類以上",null,null,null,null,"件",null,null,"件",null,null,"件",null,null,"件"]
[]
["３　情報通信機器を用いた精神療法の件数"]
[null,null,null,null,"対面診療で実施した\n精神療法の算定件数",null,null,null,null,null,"情報通信機器を用いた\n精神療法の算定件数"]
[null,null,null,null,"30分以上の場合\n※通院・在宅精神療法の「１」ロ\n「１」ハ(１)\n「２」ロ\n「２」ハ(１)\n「２」ハ(２)\nの件数の合計",null,null,"30分未満の場合\n※通院・在宅精神療法の\n「１」ハ(２)\n「２」ハ(３)\nの件数の合計",null,null,"30分以上の場合\n※通院・在宅精神療法の\n「１」ハ(１)①\nの件数",null,null,"30分未満の場合\n※通院・在宅精神療法の\n「１」ハ(２)①\nの件数"]
[null,"８月",null,null,null,null,"件",null,null,"件",null,null,"件",null,null,"件"]
[null,"９月",null,null,null,null,"件",null,null,"件",null,null,"件",null,null,"件"]
[null,"10月",null,null,null,null,"件",null,null,"件",null,null,"件",null,null,"件"]
[null,"11月",null,null,null,null,"件",null,null,"件",null,null,"件",null,null,"件"]
[null,"12月",null,null,null,null,"件",null,null,"件",null,null,"件",null,null,"件"]
[null,"１月",null,null,null,null,"件",null,null,"件",null,null,"件",null,null,"件"]
[null,"２月",null,null,null,null,"件",null,null,"件",null,null,"件",null,null,"件"]
[null,"３月",null,null,null,null,"件",null,null,"件",null,null,"件",null,null,"件"]
[null,"４月",null,null,null,null,"件",null,null,"件",null,null,"件",null,null,"件"]
[null,"５月",null,null,null,null,"件",null,null,"件",null,null,"件",null,null,"件"]
[null,"６月",null,null,null,null,"件",null,null,"件",null,null,"件",null,null,"件"]
[null,"７月",null,null,null,null,"件",null,null,"件",null,null,"件",null,null,"件"]
[]
["［記載上の注意］"]
["１","本報告については、「２の(３)」以外は前年８月１日（前年８月１日以降に「情報通信機器を用いた精神療法」に係る届出を行った場合は当該届出日）～当年７月31日の診療実施状況を、「２の(３)」は当年５月１日（当年５月１日以降に「情報通信機器を用いた精神療法」に係る届出を行った場合は当該届出日）～７月31日の診療実施状況を、それぞれ記載すること。なお、診療した実績がない場合は報告の必要はない。"]
["２","「２の(２)」の「患者の所在が、上記医療機関と異なる市町村又は特別区である場合の直接の対面診療を行える体制の整備状況」については、全診療件数のうち、患者の所在が、上記医療機関と異なる市町村又は特別区である場合の割合が２割を超える場合に記載すること。なお、市町村及び特別区については診療件数の多い10箇所について記載すること。"]
["３","「２の(３)」については、当年５月１日～７月31日に情報通信機器を用いた精神療法を実施した患者に対して抗不安薬、睡眠薬、抗うつ薬、抗精神病薬を処方した件数を、抗不安薬、睡眠薬、抗うつ薬及び抗精神病薬の種類数毎に記載すること。例えば、情報通信機器を用いた精神療法を行った患者に対して、１種類の抗不安薬及び２種類の睡眠薬を処方した場合は、「１種類の抗不安薬を処方した件数」及び「２種類の睡眠薬を処方した件数」にそれぞれ１を計上する。"]
["４","「３」の「情報通信機器を用いた精神療法の件数」のうち、「対面診療で実施した精神療法の算定件数」については、情報通信機器を用いた精神療法を実施していない患者を含む全ての患者を対象として報告すること。"]
[null,null,null,null,null,null,null,null,"保険医療機関コード",null,null,{"$f":"I5","v":""}]

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["（別紙様式２６）"]
["情報通信機器を用いた診療に係る報告書（歯科）（８月報告）"]
["（令和６年８月１日）"]
[null,null,null,null,"保険医療機関名",{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[null,null,null,null,"医療機関コード",{"$f":"IF(data!C1=\"\", \"\", data!C1)","v":""}]
[null,null,null,null,"※レセプトに記載する７桁の数字を記載すること。"]
[null,null,null,null,"郵便番号",""]
[null,null,null,null,"所在地",""]
[]
["１　情報通信機器を用いた診療実施状況"]
["患者の所在毎の情報通信機器を用いた診療実施状況"]
[null,"診療件数","そのうち、「自身では対応困難な疾患・病態の患者や緊急性が有る場合」として、他の医療機関へ紹介を実施したものの件数"]
["患者の所在が、上記医療機関と同一の市町村又は特別区である場合（①）"]
["患者の所在が、上記医療機関と異なる市町村又は特別区である場合（②）"]
["全診療件数のうち、患者の所在が、上記医療機関と異なる市町村又は特別区である場合の割合（②/(①＋②）)",{"$f":"IFERROR((B14/(B13+B14))*100,\"\")","v":""}]
["２　情報通信機器を用いた診療の件数"]
[null,null,"対面診療で実施した診療の算定件数",null,null,null,"情報通信機器を用いた診療の算定件数"]
[null,null,"初診料",null,"再診料",null,"初診料",null,null,"再診料"]
["８月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[]
[]
["９月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[]
[]
["１０月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[]
[]
["１１月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[]
[]
["１２月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[]
[]
["１月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[]
[]
["２月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[]
[]
["３月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[]
[]
["４月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[]
[]
["５月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[]
[]
["６月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[]
[]
["７月",null,null,"件",null,"件",null,null,"件",null,null,"件"]
[]
[]
["記載上の注意"]
["１　 本報告については、前年８月１日又は「歯科点数表の初診料の注 16 及び再診料の注 12」に係る届出を行った日～当年７月３１日の診療実施状況を記載すること。\n２　「２ 情報通信機器を用いた診療の件数」のうち「対面診療で実施した診療の算定件数」については、情報通信機器を用いた診療を実施していない患者を含む全ての患者を対象として報告して下さい。"]

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["（別紙様式２７）"]
["歯科点数表の初診料の注１の施設基準に係る報告書（８月報告）"]
["（令和６年８月１日）"]
[null,null,null,"所在地",null,""]
[null,null,null,"保険医療機関名",null,{"$f":"data!E1","v":""}]
[null,null,null,"保険医療機関コード（レセプトに記載する７桁の数字を記載）",null,null,{"$f":"data!C1","v":""}]
[]
["１　 当該保険医療機関の平均患者数及び滅菌体制の実績"]
[null,"概要"]
["１日平均患者数\n（届出前３ヶ月間）\n（該当する番号を選択）",""]
["滅菌体制\n（該当する番号に☑）",false]
[null,false]
[null,false,null,"（業者名：","",null,null,null,null," ）"]
["「１．診療室内に設置した滅菌器を使用」に該当する場合は以下について記載"]
["滅菌の体制について\n（１日あたりの滅菌の実施回数）\n（該当する番号を選択）",""]
[]
["２　 当該保険医療機関に設置されている歯科用ハンドピース・ユニットの保有状況"]
["機器名",null,"概要"]
["歯科用ハンドピース\n（歯科診療室用機器に限る）",null,"保有数"]
["歯科用ユニット数",null,"保有数"]
["※ 歯科用ハンドピースの保有数の欄には以下の一般的名称の機器の保有数の合計を記載すること。\n歯科用ガス圧式ハンドピース、歯科用電動式ハンドピース、ストレート・ギアードアングルハンドピース、歯科用空気駆動式ハンドピース"]
[]
["３　　常勤歯科医師の院内感染防止対策（標準予防策及び新興感染症に対する対策）に関する研修の受講歴等\n（４年以内の受講について記入すること）"]
["受講者名\n（常勤歯科医師名）","研修名\n（テーマ）",null,"受講年月日","当該研修会の主催者"]
[null,null,null,""]
[null,null,null,""]
[]
["４　当該保険医療機関における院内研修の実施状況（該当するものを選択。）"]
[]
[]
["方法",false,null,null,false]
["内容",false,null,false,null,false]
[null,false,null,null,null,false]
[null,false,null,null,null,false]
[null,false]

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[]
["（別紙様式２８）"]
[]
["リハビリテーション・栄養・口腔連携体制加算\n及びリハビリテーション・栄養・口腔連携加算\nに係る報告書（８月報告）"]
[]
[null,"都道府県名",null,null,null,null,null,{"$f":"IF(data!B1=\"\",\"\",VLOOKUP(data!B1,list!A3:C49,3,FALSE))","v":""}]
[null,"医療機関コード※",null,null,null,null,null,{"$f":"IF(data!C1=\"\", \"\", data!C1)","v":""}]
[null,"保険医療機関名",null,null,null,null,null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[null,"※レセプトに記載する７桁の数字を記載すること"]
[]
["【病棟１】"]
[null,"届出病棟名",null,null,null,null,null,""]
[null,"病床数"]
[]
["１）早期リハビリテーション実施割合"]
["（①～⑨についての）算出期間　（直近１年間もしくは３月間）"]
[null,null,null,null,null,null,null,null,null,"（",null,null,"年",null,"月",null,"日","～",null,null,"年",null,"月",null,"日）"]
["①　当該病棟を退院又は転棟した患者のうち疾患別リハビリテーション料が算定された患者数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["②　①のうち、入棟後３日（入棟日の翌々日）までに疾患別リハビリテーション料が算定された患者数　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["③　②／①　（80％以上）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(ROUNDDOWN((R19/R18)*100,1),\"\")","v":""},null,null,null,null,null,null,"％"]
[]
["２）土日祝日リハビリテーション実施状況"]
["④　当該病棟における平日における１日あたりの疾患別リハビリテーション料の提供単位数／平日における１日平均入院患者数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"単位／日・人"]
["⑤　当該病棟における土日祝日における１日あたりの疾患別リハビリテーション料の提供単位数／土日祝日における１日平均入院患者数　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"単位／日・人"]
["⑥　⑤／④　（80％以上）　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(ROUNDDOWN((R24/R23)*100,1),\"\")","v":""},null,null,null,null,null,null,"％"]
[]
["３）患者のＡＤＬ（Barthel Index）"]
["⑦　当該病棟を退院又は転棟した患者数（死亡退院及び終末期のがん患者を除く）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["⑧　⑦のうち、退院又は転棟時におけるADLが入院時等と比較して低下した患者数　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["⑨　⑧／⑦　（３％未満）　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(ROUNDDOWN((R29/R28)*100,1),\"\")","v":""},null,null,null,null,null,null,"％"]
[]
["４）褥瘡の院内発生率"]
["⑩　調査日（報告日の前月の初日）の当該病棟の入院患者数\n（調査日の入院又は予定入院患者は含まず、退院又は退院予定の患者は含める）　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["⑪　調査日に褥瘡（DESIGN-R2020分類d２以上）を保有する患者のうち、入院時既に褥瘡保有が記録された患者を除いた患者数　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["⑫　⑪／⑩　（２．５％未満）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(IF(AND(R33<=80,R34<=2),\"\",ROUNDDOWN((R34/R33)*100,2)),\"\")","v":""},null,null,null,null,null,null,"％"]
[]
["【病棟２】"]
[null,"届出病棟名",null,null,null,null,null,""]
[null,"病床数"]
[]
["１）早期リハビリテーション実施割合"]
["（①～⑨についての）算出期間　（直近１年間もしくは３月間）"]
[null,null,null,null,null,null,null,null,null,"（",null,null,"年",null,"月",null,"日","～",null,null,"年",null,"月",null,"日）"]
["①　当該病棟を退院又は転棟した患者のうち疾患別リハビリテーション料が算定された患者数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["②　①のうち、入棟後３日（入棟日の翌々日）までに疾患別リハビリテーション料が算定された患者数　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["③　②／①　（80％以上）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(ROUNDDOWN((R45/R44)*100,1),\"\")","v":""},null,null,null,null,null,null,"％"]
[]
["２）土日祝日リハビリテーション実施状況"]
["④　当該病棟における平日における１日あたりの疾患別リハビリテーション料の提供単位数／平日における１日平均入院患者数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"単位／日・人"]
["⑤　当該病棟における土日祝日における１日あたりの疾患別リハビリテーション料の提供単位数／土日祝日における１日平均入院患者数　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"単位／日・人"]
["⑥　⑤／④　（80％以上）　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(ROUNDDOWN((R50/R49)*100,1),\"\")","v":""},null,null,null,null,null,null,"％"]
[]
["３）患者のＡＤＬ（Barthel Index）"]
["⑦　当該病棟を退院又は転棟した患者数（死亡退院及び終末期のがん患者を除く）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["⑧　⑦のうち、退院又は転棟時におけるADLが入院時等と比較して低下した患者数　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["⑨　⑧／⑦　（３％未満）　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(ROUNDDOWN((R55/R54)*100,1),\"\")","v":""},null,null,null,null,null,null,"％"]
[]
["４）褥瘡の院内発生率"]
["⑩　調査日（報告日の前月の初日）の当該病棟の入院患者数\n（調査日の入院又は予定入院患者は含まず、退院又は退院予定の患者は含める）　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["⑪　調査日に褥瘡（DESIGN-R2020分類d２以上）を保有する患者のうち、入院時既に褥瘡保有が記録された患者を除いた患者数　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["⑫　⑪／⑩　（２．５％未満）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(IF(AND(R59<=80,R60<=2),\"\",ROUNDDOWN((R60/R59)*100,2)),\"\")","v":""},null,null,null,null,null,null,"％"]
[]
["【病棟３】"]
[null,"届出病棟名",null,null,null,null,null,""]
[null,"病床数"]
[]
["１）早期リハビリテーション実施割合"]
["（①～⑨についての）算出期間　（直近１年間もしくは３月間）"]
[null,null,null,null,null,null,null,null,null,"（",null,null,"年",null,"月",null,"日","～",null,null,"年",null,"月",null,"日）"]
["①　当該病棟を退院又は転棟した患者のうち疾患別リハビリテーション料が算定された患者数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["②　①のうち、入棟後３日（入棟日の翌々日）までに疾患別リハビリテーション料が算定された患者数　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["③　②／①　（80％以上）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(ROUNDDOWN((R71/R70)*100,1),\"\")","v":""},null,null,null,null,null,null,"％"]
[]
["２）土日祝日リハビリテーション実施状況"]
["④　当該病棟における平日における１日あたりの疾患別リハビリテーション料の提供単位数／平日における１日平均入院患者数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"単位／日・人"]
["⑤　当該病棟における土日祝日における１日あたりの疾患別リハビリテーション料の提供単位数／土日祝日における１日平均入院患者数　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"単位／日・人"]
["⑥　⑤／④　（80％以上）　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(ROUNDDOWN((R76/R75)*100,1),\"\")","v":""},null,null,null,null,null,null,"％"]
[]
["３）患者のＡＤＬ（Barthel Index）"]
["⑦　当該病棟を退院又は転棟した患者数（死亡退院及び終末期のがん患者を除く）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["⑧　⑦のうち、退院又は転棟時におけるADLが入院時等と比較して低下した患者数　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["⑨　⑧／⑦　（３％未満）　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(ROUNDDOWN((R81/R80)*100,1),\"\")","v":""},null,null,null,null,null,null,"％"]
[]
["４）褥瘡の院内発生率"]
["⑩　調査日（報告日の前月の初日）の当該病棟の入院患者数\n（調査日の入院又は予定入院患者は含まず、退院又は退院予定の患者は含める）　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["⑪　調査日に褥瘡（DESIGN-R2020分類d２以上）を保有する患者のうち、入院時既に褥瘡保有が記録された患者を除いた患者数　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["⑫　⑪／⑩　（２．５％未満）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(IF(AND(R85<=80,R86<=2),\"\",ROUNDDOWN((R86/R85)*100,2)),\"\")","v":""},null,null,null,null,null,null,"％"]
[]
["【病棟４】"]
[null,"届出病棟名",null,null,null,null,null,""]
[null,"病床数"]
[]
["１）早期リハビリテーション実施割合"]
["（①～⑨についての）算出期間　（直近１年間もしくは３月間）"]
[null,null,null,null,null,null,null,null,null,"（",null,null,"年",null,"月",null,"日","～",null,null,"年",null,"月",null,"日）"]
["①　当該病棟を退院又は転棟した患者のうち疾患別リハビリテーション料が算定された患者数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["②　①のうち、入棟後３日（入棟日の翌々日）までに疾患別リハビリテーション料が算定された患者数　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["③　②／①　（80％以上）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(ROUNDDOWN((R97/R96)*100,1),\"\")","v":""},null,null,null,null,null,null,"％"]
[]
["２）土日祝日リハビリテーション実施状況"]
["④　当該病棟における平日における１日あたりの疾患別リハビリテーション料の提供単位数／平日における１日平均入院患者数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"単位／日・人"]
["⑤　当該病棟における土日祝日における１日あたりの疾患別リハビリテーション料の提供単位数／土日祝日における１日平均入院患者数　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"単位／日・人"]
["⑥　⑤／④　（80％以上）　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(ROUNDDOWN((R102/R101)*100,1),\"\")","v":""},null,null,null,null,null,null,"％"]
[]
["３）患者のＡＤＬ（Barthel Index）"]
["⑦　当該病棟を退院又は転棟した患者数（死亡退院及び終末期のがん患者を除く）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["⑧　⑦のうち、退院又は転棟時におけるADLが入院時等と比較して低下した患者数　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["⑨　⑧／⑦　（３％未満）　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(ROUNDDOWN((R107/R106)*100,1),\"\")","v":""},null,null,null,null,null,null,"％"]
[]
["４）褥瘡の院内発生率"]
["⑩　調査日（報告日の前月の初日）の当該病棟の入院患者数\n（調査日の入院又は予定入院患者は含まず、退院又は退院予定の患者は含める）　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["⑪　調査日に褥瘡（DESIGN-R2020分類d２以上）を保有する患者のうち、入院時既に褥瘡保有が記録された患者を除いた患者数　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["⑫　⑪／⑩　（２．５％未満）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(IF(AND(R111<=80,R112<=2),\"\",ROUNDDOWN((R112/R111)*100,2)),\"\")","v":""},null,null,null,null,null,null,"％"]
[]
["【病棟５】"]
[null,"届出病棟名",null,null,null,null,null,""]
[null,"病床数"]
[]
["１）早期リハビリテーション実施割合"]
["（①～⑨についての）算出期間　（直近１年間もしくは３月間）"]
[null,null,null,null,null,null,null,null,null,"（",null,null,"年",null,"月",null,"日","～",null,null,"年",null,"月",null,"日）"]
["①　当該病棟を退院又は転棟した患者のうち疾患別リハビリテーション料が算定された患者数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["②　①のうち、入棟後３日（入棟日の翌々日）までに疾患別リハビリテーション料が算定された患者数　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["③　②／①　（80％以上）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(ROUNDDOWN((R123/R122)*100,1),\"\")","v":""},null,null,null,null,null,null,"％"]
[]
["２）土日祝日リハビリテーション実施状況"]
["④　当該病棟における平日における１日あたりの疾患別リハビリテーション料の提供単位数／平日における１日平均入院患者数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"単位／日・人"]
["⑤　当該病棟における土日祝日における１日あたりの疾患別リハビリテーション料の提供単位数／土日祝日における１日平均入院患者数　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"単位／日・人"]
["⑥　⑤／④　（80％以上）　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(ROUNDDOWN((R128/R127)*100,1),\"\")","v":""},null,null,null,null,null,null,"％"]
[]
["３）患者のＡＤＬ（Barthel Index）"]
["⑦　当該病棟を退院又は転棟した患者数（死亡退院及び終末期のがん患者を除く）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["⑧　⑦のうち、退院又は転棟時におけるADLが入院時等と比較して低下した患者数　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["⑨　⑧／⑦　（３％未満）　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(ROUNDDOWN((R133/R132)*100,1),\"\")","v":""},null,null,null,null,null,null,"％"]
[]
["４）褥瘡の院内発生率"]
["⑩　調査日（報告日の前月の初日）の当該病棟の入院患者数\n（調査日の入院又は予定入院患者は含まず、退院又は退院予定の患者は含める）　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["⑪　調査日に褥瘡（DESIGN-R2020分類d２以上）を保有する患者のうち、入院時既に褥瘡保有が記録された患者を除いた患者数　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名"]
["⑫　⑪／⑩　（２．５％未満）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(IF(AND(R137<=80,R138<=2),\"\",ROUNDDOWN((R138/R137)*100,2)),\"\")","v":""},null,null,null,null,null,null,"％"]
[]
["[記載上の注意]\n１．①～⑨については、前年８月１日（又は届出日）～当年７月31日の診療実施状況を記載すること。１年間の実績を報告する場合、算出期間について記載する必要はない。\n２．⑪については、⑩の患者のうち、DESIGN-R2020分類ｄ２以上を有する患者数を記入する（１名の患者が複数の褥瘡を有していても、患者１名として数える。）。\n３．⑩の入院患者数が80人以下の場合は、⑪が2人以下であること。この場合、⑫は記載する必要はない。"]

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["（別紙様式２９）",null,"（令和６年８月１日現在）"]
[]
["医療上必要があると認められない、患者の都合による精子の凍結又は融解の実施状況報告書"]
[]
[null,null,null,"都道府県名",null,{"$f":"IF(data!B1=\"\",\"\",VLOOKUP(data!B1,list!A3:C49,3,FALSE))","v":""}]
[]
[null,null,null,"医療機関コード",null,{"$f":"IF(data!C1=\"\",\"\",data!C1)","v":""}]
[null,null,null,"　※レセプトに記載する７桁の数字を記載すること。"]
[null,null,null,"保険医療機関名",null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[]
[]
["精子の凍結又は融解の実施件数","患者からの徴収額（消費税を含む。）\n（※記載上の注意　２．を参照）"]
[null,null,null,null,null,null,"円"]
[]
["〔記載上の注意〕\n\n １．本報告については、前年８月１日～当年７月３１日の実施状況を記載すること。\n     なお、徴収した実績がない場合は報告の必要はない。\n\n ２．「患者からの徴収額」は、精子の凍結又は融解に係る特別の料金として医療機関内に\n　　掲示した金額を記入すること。\n\n ３．精子の凍結又は融解に係る特別の料金に事前の報告と相違がある場合は、速やかに\n　　変更の報告を行うこと。"]

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["（別紙様式３０）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（令和６年８月１日現在）"]
[]
["プログラム医療機器の使用等（評価療養）に関する実施状況報告書"]
[]
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[]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保険医療機関名",null,null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[]
["１．医薬品医療機器等法に基づく承認（第１段階承認）を受けたプログラム医療機器の使用等"]
["販売名","医療機器承認番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"使用等回数\n又は人数（※記載上の注意　３．を参照）",null,"患者からの徴収額（消費税を含む。）\n（※記載上の注意　４．を参照）",null,null,null,null,"徴収額に対応する使用期間（※記載上の注意　４．を参照）"]
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["","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回",null,null,null,null,"円",null,"か月"]
[]
["２．保険適用されていない範囲における使用に係る有効性に関する使用成績を踏まえた再評価を目指すプログラム医療機器の使用等"]
["販売名","医療機器承認番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"使用等回数\n又は人数（※記載上の注意　３．を参照）",null,"患者からの徴収額\n（※記載上の注意　４．を参照）",null,null,null,null,"徴収額に対応する使用期間（※記載上の注意　４．を参照）"]
["","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回",null,null,null,null,"円",null,"か月"]
["","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回",null,null,null,null,"円",null,"か月"]
["","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回",null,null,null,null,"円",null,"か月"]
["","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回",null,null,null,null,"円",null,"か月"]
["","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回",null,null,null,null,"円",null,"か月"]
["","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回",null,null,null,null,"円",null,"か月"]
["","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回",null,null,null,null,"円",null,"か月"]
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["","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回",null,null,null,null,"円",null,"か月"]
[]
["〔記載上の注意〕\n\n １．本報告については、前年８月１日～当年７月３１日の実施状況を記載すること。\n     なお、徴収した実績がない場合は報告の必要はない。\n\n ２．「医療機器承認番号」について、医薬品医療機器等法上の医療機器承認番号を記載すること。\n\n ３．「使用等回数又は人数」について、患者自身が医療機関外で継続的に使用するもの以外については、医療機関において当該プログラム医療機器の使用又は支給を実施した回数を記載し、患者自身が医療機関外で継続的に使用するものについては、使用した患者数を記載すること。\n\n ４．「患者からの徴収額」は、プログラム医療機器の使用等に係る特別の料金として医療機関内に掲示した金額を記入すること。また、患者自身が継続的に使用するものについては、徴収額に対応する使用期間も記載すること。\n\n ５．プログラム医療機器の使用等に係る特別の料金に事前の報告と相違がある場合は、速やかに変更の報告を行うこと。"]

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["（別紙様式３１）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（令和６年８月１日現在）"]
[]
["プログラム医療機器の使用等（選定療養）に関する実施状況報告書"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"都道府県名",null,null,null,{"$f":"IF(data!B1=\"\",\"\",VLOOKUP(data!B1,list!A3:C49,3,FALSE))","v":""}]
[]
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[]
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["","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人",null,null,null,null,null,"円",null,"か月"]
["","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人",null,null,null,null,null,"円",null,"か月"]
[]
["〔記載上の注意〕\n\n １．本報告については、前年８月１日～当年７月３１日の実施状況を記載すること。\n     なお、徴収した実績がない場合は報告の必要はない。\n\n ２．「医療機器承認番号」について、医薬品医療機器等法上の医療機器承認番号を記載すること。\n\n ３．「人数」について、使用した患者数を記載すること。\n\n ４．「患者からの徴収額」は、プログラム医療機器の使用等に係る特別の料金として医療機関内に掲示した金額を記入すること。また、徴収額に対応する使用期間も記載すること。\n\n ５．プログラム医療機器の使用等に係る特別の料金に事前の報告と相違がある場合は、速やかに変更の報告を行うこと。"]

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["（別紙様式３２）",null,"（令和６年８月１日現在）"]
[]
["間歇スキャン式持続血糖測定器の使用の実施状況報告書"]
[]
[null,"都道府県名",null,{"$f":"IF(data!B1=\"\",\"\",VLOOKUP(data!B1,list!A3:C49,3,FALSE))","v":""}]
[]
[null,"医療機関コード",null,{"$f":"IF(data!C1=\"\",\"\",data!C1)","v":""}]
[null,"　※レセプトに記載する７桁の数字を記載すること。"]
[null,"保険医療機関名",null,{"$f":"IF(data!E1=\"\",\"\",data!E1)","v":""}]
[]
[]
["間歇スキャン式持続血糖測定器の使用の実施件数","患者からの徴収額（消費税を含む。）\n（※記載上の注意　２．を参照）"]
[null,null,null,null,null,null,"円"]
[]
["〔記載上の注意〕\n\n １．本報告については、前年８月１日～当年７月３１日の実施状況を記載すること。\n     なお、徴収した実績がない場合は報告の必要はない。\n\n ２．「患者からの徴収額」は、間歇スキャン式持続血糖測定器の使用に係る特別の料金として医療機関内に掲示した金額を記入すること。\n\n ３．間歇スキャン式持続血糖測定器の使用に係る特別の料金に事前の報告と相違がある場合は、速やかに変更の報告を行うこと。"]